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Clinical Trial Details — Status: Recruiting

Administrative data

NCT number NCT04723199
Other study ID # 102
Secondary ID
Status Recruiting
Phase
First received
Last updated
Start date December 16, 2020
Est. completion date December 31, 2021

Study information

Verified date January 2021
Source Istituto Clinico Humanitas
Contact Benedetto Mangiavillano, MD
Phone (+39) 0331 476205 - 381
Email benedetto.mangiavillano@mc.humanitas.it
Is FDA regulated No
Health authority
Study type Observational

Clinical Trial Summary

Distal malignant biliary obstruction results from different types of tumors including pancreatic cancer, biliary tract cancer (BTC), gallbladder cancer, and metastasis, which can lead to obstructive jaundice. Endoscopic retrograde cholangiopancreatography (ERCP) represents the gold standard for jaundice palliation in this setting of patients. However, surgically altered anatomy (i.e., Whipple intervention, Roux-en-Y gastric bypass, Billroth II surgery), periampullary diverticula, gastric outlet obstruction, and malignant obstruction of the lumen determine the failure of the procedure in about 5-10% of cases, requiring alternative methods of decompression. Percutaneous transhepatic biliary drainage (PTBD) and surgical bypass are well established alternatives in these patients, but associated with increased morbidity, longer length of hospital stay and higher costs, and patient discomfort. In 2001 Giovannini et al. described the first EUS guided biliary drainage (EUS-BD) through a transduodenal access with a needle knife. Subsequently, EUS-BD has considerably evolved thanks to the development of dedicated devices such as lumen apposing metal stents (LAMS), specifically designed for endoscopic ultrasound procedures. LAMS are made up of braided nitinol, that is fully covered with silicone to prevent tissue ingrowth, with wide flanges on both ends to provide anchorage. Recently, LAMS have been incorporated into a delivery system with an electrocautery mounted on the tip (Hot Axios; Boston Scientific Corp.), which allows the device to be used directly to penetrate the target structure without the need to utilize a 19G needle, a guidewire, and a cystotome for prior dilation. This has been described for drainage of peri-pancreatic fluid collections, common bile duct (CBD), gallbladder, and for creation of gastro-jejuno anastomosis. The biliary drainage procedure performed with the Hot Axios sistem is a one step procedure that requires less or no need for accessory exchange and becomes faster, thus potentially decreasing the risk of complications. The procedure has been described as safe and effective with a technical success of 98.2 %, clinical success of 96.4 %, and low rate of complications 7 % (duodenal perforations, bleeding and transient cholangitis). A systematic review and meta-analyses showed clinical and technical success rates of 87% and 95% respectively. Currently, the EUS-BD is indicated as a rescue therapy for jaundice palliation after ERCP failure.


Recruitment information / eligibility

Status Recruiting
Enrollment 20
Est. completion date December 31, 2021
Est. primary completion date December 31, 2021
Accepts healthy volunteers No
Gender All
Age group 18 Years and older
Eligibility Inclusion Criteria: - Age =18 years - Patients with distal malignant biliary obstruction - Dilated common bile duct (>15 mm diameter) at either abdominal ultrasound, computed tomography, magnetic resonance or EUS or accessible gallbladder from the duodenum or from the stomach for the drainage - Agree to receive follow up phone calls - Able to provide written informed consent Exclusion Criteria: - Coagulation and/or platelets hereditary disorders and/or INR>1.5, PLT<50,000 - Use of anticoagulants that cannot be discontinued - Pregnant women - Inability to sign the informed consent

Study Design


Related Conditions & MeSH terms


Intervention

Device:
Electrocautetery LAMS
Electrocautetery LAMS

Locations

Country Name City State
Italy Humanitas Mater Domini Castellanza

Sponsors (1)

Lead Sponsor Collaborator
Istituto Clinico Humanitas

Country where clinical trial is conducted

Italy, 

Outcome

Type Measure Description Time frame Safety issue
Primary Rate of technical success The rate of successful LAMS placement in the targeted organ 12 Months
Primary Rate of clinical success Decrease of the total bilirubin levels > 20% at 24 hours after procedure 12 Months
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