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Clinical Trial Details — Status: Recruiting

Administrative data

NCT number NCT04577456
Other study ID # TICL-001 G190281
Secondary ID
Status Recruiting
Phase N/A
First received
Last updated
Start date October 15, 2022
Est. completion date September 2024

Study information

Verified date August 2023
Source Databean
Contact John Davidson
Phone +6498879309
Email john@insidescompany.com
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

This project aims to introduce and evaluate a novel assistive prosthetic system that helps prevent and treat nutrient and fluid loss from enterocutaneous fistulas. The device system functions simply to return the output from a fistula back into the distal limb of the intestine.


Description:

The development of enterocutaneous fistulas are devastating consequences of surgery or surgical diseases. They cause excessive fluid and nutrient losses from the gut resulting in severe dehydration and intestinal failure mandating invasive medical therapies to improve survival. These disorders inflict a vast burden of suffering, morbidity, and mortality on patients, while extracting enormous per-patient resources from healthcare systems. Parenteral nutrition is often required, meaning prolonged hospital stay, an attendant risk of line sepsis, venous damage and thrombosis, liver impairment, and death. There is a pressing demand for breakthrough technologies that can restore lost fluids and nutrients to the body in patients affected by enterocutaneous fistulas in order to reverse intestinal failure, eliminate the need for parenteral nutrition, prevent dehydration and renal injury, allow safe care in the community, enable chemotherapy completion, and restore quality of life.


Recruitment information / eligibility

Status Recruiting
Enrollment 40
Est. completion date September 2024
Est. primary completion date September 2024
Accepts healthy volunteers No
Gender All
Age group 21 Years and older
Eligibility Inclusion Criteria: - Age = 21 years - Able to provide written informed consent - Dependent on parenteral nutrition (PN) - DES/ECF with exposed afferent and efferent limbs visible on the abdominal wall - Minimum of 2 weeks post DES/ECF creation - Distal limb of DES/ECF opening can be intubated by a minimum 24Fr feeding tube (dilatation of orifice strictures is allowable) Exclusion Criteria: - Insufficient distal access channel (distal limb) for device insertion - Bowel obstruction proximal to the DES/ECF - Small bowel obstruction, anastomotic leak, or perforation distal to the DES/ECF (diagnostic procedure such as gastrografin test, fistulograms, or similar must be performed, if there is a distal anastomosis with integrity not previously evaluated, to ensure that the subject is eligible) - Scheduled for DES/ECF reversal within 4 weeks of enrolment date - Current infection with Clostridium difficile colitis - Current infection small intestinal bacterial overgrowth (SIBO) - Signs or symptoms of systemic infection - Pre-existing gastrointestinal motility disorders including slow transit constipation, outlet obstruction, fecal incontinence, and gastroparesis - Metabolic, neurogenic, or endocrine disorders known to cause colonic dysmotility, e.g., multiple sclerosis, Parkinson's disease, hypothyroidism - Known peritoneal metastatic disease prior to DES/ECF closure (acceptable if only discovered at time of closure) - Liver cirrhosis - Hereditary coagulopathy, e.g., von Willebrand disease - Severe chronic renal insufficiency prior to DES/ECF formation (eGFR<30mL/min/1.73m2) - Active implantable medical devices such as neuromodulation and cardiac systems - Metal stents implanted within 20cm of expected use of the controller - Women who are pregnant or breastfeeding - Subjects participating in an interventional clinical study within 30 days prior to randomization

Study Design


Intervention

Device:
The Insides System
Novel pump designed to return effluent from the ostomy bag to the distal gut

Locations

Country Name City State
United Kingdom Addenbrooke's Hospital Cambridge
United Kingdom St James Hospital Leeds
United Kingdom St Marks Hospital London
United Kingdom Nottingham University Hospital Nottingham
United Kingdom University Hospital Southampton Southampton
United States Massachusetts General Medical Center Boston Massachusetts
United States University Illinois Chicago Illinois
United States Henry Ford Medical Center Detroit Michigan
United States Shands Hospital Gainesville Florida
United States University Nebraska Lincoln Nebraska
United States University Miami Hospital and Clinics Miami Florida

Sponsors (2)

Lead Sponsor Collaborator
Databean The Insides Company

Countries where clinical trial is conducted

United States,  United Kingdom, 

Outcome

Type Measure Description Time frame Safety issue
Primary Efficacy - Proportion of subjects who discontinue the use of parenteral nutrition at 30 days Between group comparison of the proportion of subjects who discontinue the use of parenteral nutrition 30 days post randomization
Secondary Efficacy - Between group comparison of the time to discontinuation of parenteral nutrition Between group comparison of the time to discontinuation of parenteral nutrition measured in days 30 days
Secondary Efficacy - Between group comparison of the time to fistula closure Between group comparison of the time to surgery for fistula closure measured in days 90 days
Secondary Safety - Between group comparison of the incidence of serious adverse events Between group comparison of the incidence of serious adverse events such as dehydration, metabolic disarray, failure to complete prescribed chemotherapy, IV line complications, fistula complications, device related effects 90 days
Secondary Safety - Between group comparison of medication use to control fluid loss due to high output enterostomies Between group comparison of the use of proton pump inhibitors, anti motility agents, histamine receptor antagonists, a2 receptor antagonists, and somatostatins. 30 and 90 days
Secondary Safety - Between group comparison of nutritional failure measured by the nutritional risk index (NRI) Between group comparison of the nutritional risk index (NRI). Nutritional failure risk will be categorized as severe (NRI<83.5), moderate (NRI 83.5 - 97.5) and low (NRI>97.5). 30 and 90 days
Secondary Safety - Between group comparison of peristomal skin complications Between group comparison of peristomal skin complications measured by the discoloration, erosion, tissue overgrowth (DET) score as mild, moderate or severe 30 and 90 days
Secondary Healthcare Utilization - Between group comparison of length of stay for index hospitalization Between group comparison of length of stay for index hospitalization measured from the day of randomization to discharge up to 30 days
Secondary Healthcare Utilization - Between group comparison of all cause hospitalizations Between group comparison of all cause hospitalizations measured by the total number of discreet hospitalizations >24 hours in duration 90 days
Secondary Healthcare Utilization - Between group comparison of hospitalizations due to dehydration Between group comparison of hospital admissions >24 hours duration where the primary reason for admission is dehydration 90 days
Secondary Device performance - The overall incidence of device related adverse effects The overall incidence of device related adverse effects reported in subjects randomized to the device. Effects may include effluent cycling time, device wear, device failure. 90 days
Secondary Quality of Life - Between group comparison of quality of life indices as measured by the EuroQol 5D Between group comparison of quality of life as measured by the following:
EuroQol 5D scale - a five question survey and health thermometer where 0= the worst health you can imagine and 100= the best health you can imagine.
Stoma QoL - This questionnaire consists of 20 questions. An example of a question could be: "I worry that the pouch will loosen." All the questions must be answered on a 4-point scale. The options for answering each question are:
Always
Sometimes
Rarely
Not at all
30 and 90 days
Secondary Quality of Life - Between group comparison of quality of life indices as measured by the Stoma QoL Questionnaire Stoma QoL - This questionnaire consists of 20 questions. An example of a question could be: "I worry that the pouch will loosen." All the questions must be answered on a 4-point scale. The options for answering each question are:
Always
Sometimes
Rarely
Not at all
30 and 90 days
Secondary Quality of Life - Between group comparison of quality of life indices as measured by the Beck Depression Inventory Beck Depression Inventory - a 21 question survey where each question has 4 possible answers scored 0-3. The total score is summed to give an overall level of depression
1-10____________________These ups and downs are considered normal 11-16___________________ Mild mood disturbance 17-20___________________Borderline clinical depression 21-30___________________Moderate depression 31-40___________________Severe depression over 40__________________Extreme depression
30 and 90 days
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