Clinical Trials Logo

Clinical Trial Details — Status: Recruiting

Administrative data

NCT number NCT04054713
Other study ID # R-2019-3601-143
Secondary ID
Status Recruiting
Phase N/A
First received
Last updated
Start date July 3, 2019
Est. completion date December 1, 2022

Study information

Verified date July 2022
Source Coordinación de Investigación en Salud, Mexico
Contact Oscar V Hernández Mondragón, MD
Phone +525556276900
Email mondragonmd@yahoo.co.uk
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

Barrett's esophagus is a complication of chronic gastroesophageal reflux disease that occurs in up to 10% to 15% of patients with this pathology. Well-defined risk factors have been established and are important because they are considered a precancerous lesion (intestinal metaplasia). The conventional diagnostic methods are ineffective in reliably detecting potentially treatable lesions. Investigators propose the use of vital chromoendoscopy with acetic acid using the simplified classification of Portsmouth looking for areas with loss of acetowhitening and taking targeted biopsies to increase the detection of esophageal neoplastic lesions.


Description:

Barrett's esophagus is a complication of chronic gastroesophageal reflux disease that occurs in up to 10 to 15% of patients with this disease, well-defined risk factors have been established and are important because they are considered a precancerous condition (metaplasia intestinal). Chromoendoscopy is postulated as an effective way for the detection of esophageal precancerous lesions, early detection and timely treatment with chromoendoscopy with acetic acid being a seemingly reliable alternative, so the investigators will use with the simplified classification of Portsmouth looking for areas with loss of acetowhitening and targeted biopsy to increase the detection of esophageal neoplastic lesions, our main objective being to compare the diagnostic effectiveness of directed biopsies of dysplastic lesions with acetic acid in patients with Barrett's esophagus compared to taking non-directed protocolized biopsies. A clinical trial will be carried out, including all those patients older than 18 years who go to perform a superior endoscopy with diagnosis of Barrett's esophagus where patients will be up and B Seattle protocol group(four quadrant biopsy every 2 centimeters starting 1 centimeter from above the esophagogastric junction), then proton pump inhibitor washout and crossover allocation with the opposite corresponding manoeuver. Histopathological results of both groups will be compared. Demographic data of the participants will be collected and the evaluated areas of Barrett's esophagus with each method will be recorded in a data collection sheet detailing in a specific way the number of biopsies taken, specifying if there was loss of acetowhitening and alterations in the mucous pattern and in the case of the opposite arm, the total number of biopsies taken based on the Seattle protocol, said data will be condensed into a database for subsequent statistical analysis and publication of results.


Recruitment information / eligibility

Status Recruiting
Enrollment 76
Est. completion date December 1, 2022
Est. primary completion date October 1, 2022
Accepts healthy volunteers No
Gender All
Age group 18 Years and older
Eligibility Inclusion Criteria: - Confirmed histological diagnosis of intestinal metaplasia in follow-up protocol without dysplasia - Patients whose endoscopic image is suggestive of esophageal intestinal metaplasia and is confirmed by histology - Barrett's esophagus minimally 2cm - Patients over 18 years of age who wish to participate in the study - Signed informed consent Exclusion Criteria: - Histological evidence of esophageal adenocarcinoma or known with dysplasia - History of esophageal ablative therapy - Known allergy or intolerance to proton pump inhibitors or acetic acid - Evidence of esophageal varices - Los Angeles esophagitis C or D - Uncontrolled coagulopathy (INR> 1.5 or platelets <50,000) - Pregnancy - No authorization of informed consent

Study Design


Related Conditions & MeSH terms


Intervention

Diagnostic Test:
Acetic acid chromoendoscopy
Acetic acid is prepared at a concentration of 2.5% in a 20ml syringe, it will be applied with a 7 french spray catheter compatible with a working channel 2.8mm onwards, starting the proximal application When distally performing a uniform application on the area of intestinal metaplasia and the timed time for mucous visualization in search of areas of loss of acetowhitening begins, in case of finding such area will be registered the time in which there was loss of acetowhitening, the distance at which it is located from the upper dental arch in addition to the face on which the area is located, subsequently evaluation of the glandular pattern is performed only by classifying as normal or abnormal, once this evaluation has been carried out, biopsies are directed to these areas to be sent to the pathology service.
Seattle protocol
Take random biopsies by quadrants every 2 centimeters. Biopsy of the intestinal metaplasia areas 1cm above the esophagogastric junction will be initiated, taking tissue every 2cm from the four quadrants, separating the biopsies in different bottles based on the length in which they were taken, to later be sent to the pathology service.

Locations

Country Name City State
Mexico Centro Medico Nacional Siglo XXI Hospital de Especialidades Mexico City

Sponsors (1)

Lead Sponsor Collaborator
Coordinación de Investigación en Salud, Mexico

Country where clinical trial is conducted

Mexico, 

References & Publications (7)

Chedgy F, Fogg C, Kandiah K, Barr H, Higgins B, McCord M, Dewey A, De Caestecker J, Gadeke L, Stokes C, Poller D, Longcroft-Wheaton G, Bhandari P. Acetic acid-guided biopsies in Barrett's surveillance for neoplasia detection versus non-targeted biopsies (Seattle protocol): A feasibility study for a randomized tandem endoscopy trial. The ABBA study. Endosc Int Open. 2018 Jan;6(1):E43-E50. doi: 10.1055/s-0043-120829. Epub 2018 Jan 12. — View Citation

Kandiah K, Chedgy FJQ, Subramaniam S, Longcroft-Wheaton G, Bassett P, Repici A, Sharma P, Pech O, Bhandari P. International development and validation of a classification system for the identification of Barrett's neoplasia using acetic acid chromoendoscopy: the Portsmouth acetic acid classification (PREDICT). Gut. 2018 Dec;67(12):2085-2091. doi: 10.1136/gutjnl-2017-314512. Epub 2017 Sep 28. — View Citation

Rubenstein JH, Morgenstern H, Appelman H, Scheiman J, Schoenfeld P, McMahon LF Jr, Metko V, Near E, Kellenberg J, Kalish T, Inadomi JM. Prediction of Barrett's esophagus among men. Am J Gastroenterol. 2013 Mar;108(3):353-62. doi: 10.1038/ajg.2012.446. Epub 2013 Jan 15. — View Citation

Shaheen NJ, Falk GW, Iyer PG, Gerson LB; American College of Gastroenterology. ACG Clinical Guideline: Diagnosis and Management of Barrett's Esophagus. Am J Gastroenterol. 2016 Jan;111(1):30-50; quiz 51. doi: 10.1038/ajg.2015.322. Epub 2015 Nov 3. Erratum in: Am J Gastroenterol. 2016 Jul;111(7):1077. — View Citation

Sharma P, Falk GW, Weston AP, Reker D, Johnston M, Sampliner RE. Dysplasia and cancer in a large multicenter cohort of patients with Barrett's esophagus. Clin Gastroenterol Hepatol. 2006 May;4(5):566-72. Epub 2006 Apr 17. — View Citation

Singh S, Sharma AN, Murad MH, Buttar NS, El-Serag HB, Katzka DA, Iyer PG. Central adiposity is associated with increased risk of esophageal inflammation, metaplasia, and adenocarcinoma: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2013 Nov;11(11):1399-1412.e7. doi: 10.1016/j.cgh.2013.05.009. Epub 2013 May 22. Review. — View Citation

Tholoor S, Bhattacharyya R, Tsagkournis O, Longcroft-Wheaton G, Bhandari P. Acetic acid chromoendoscopy in Barrett's esophagus surveillance is superior to the standardized random biopsy protocol: results from a large cohort study (with video). Gastrointest Endosc. 2014 Sep;80(3):417-24. doi: 10.1016/j.gie.2014.01.041. Epub 2014 Apr 6. — View Citation

Outcome

Type Measure Description Time frame Safety issue
Primary Comparing the incidence of dysplasia by directed biopsies with acetic acid chromoendoscopy against taking non-directed protocolized biopsies( Seattle protocol) in patients with Barrett's esophagus. First the investigators will detect the incidence of dysplasia in Barrett esophagus in patients with acetic acid chromoendoscopy, using the Vienna Classification system by the pathologist. Patient will be on proton pump inhibitor (PP) for 6-8 weeks
Primary Comparing the incidence of dysplasia by directed biopsies with acetic acid chromoendoscopy against taking non-directed protocolized biopsies( Seattle protocol) in patients with Barrett's esophagus. The second maneuver consist on taking non directed biopsies by the Seattle protocol in the same patient. And the incidence of dysplasia on biopsies will be looked for using Vienna Classification system again. After the wash out time of 6-8 weeks on PPI, this maneuver will be added
See also
  Status Clinical Trial Phase
Recruiting NCT03554356 - Nitrous Oxide For Endoscopic Ablation of Refractory Barrett's Esophagus (NO FEAR-BE) N/A
Recruiting NCT01398579 - Comparison Between Probe-based Confocal Laser Endomicroscopy, White-light Endoscopy and Virtual Chromoendoscopy Phase 1
Completed NCT01614418 - Radiofrequency Ablation for Gastric Metaplasia and Dysplasia Phase 1/Phase 2
Completed NCT06282484 - A Study on the Relationship Between Gastric Xanthoma and Gastric Cancer and Precancerous Lesions
Not yet recruiting NCT06085677 - The Gastric HormonE BioMarkers of Preneoplastic Lesions Study
Completed NCT01024621 - Confocal Laser Endomicroscopy for the Detection of Gastric Intestinal Metaplasia: a Randomized Controlled Trial N/A
Terminated NCT05579444 - Systems Biology of Gastrointestinal and Related Diseases
Recruiting NCT04331951 - Sensitivity of Targeted Biopsy Within Sydney Protocol for GIM N/A
Completed NCT03188406 - Gastric Cancer Precursor Lesions (GCPL) Study
Recruiting NCT05053945 - Helicobacter Pylori, Atrophic Gastritis and Intestinal Metaplasia Registry and Prospective Study
Completed NCT02075905 - Stratifying Risk in Barrett's Esophagus: A Pilot Study for Biomarker-based Patient Management N/A
Completed NCT01374074 - Racial Disparity in Barrett's Esophagus N/A
Recruiting NCT02457624 - Gastric Cancer Screening Quality Improvement System Establishment N/A
Recruiting NCT05818072 - The Prevalence, Risk Factors and Optimal Biopsy Protocol of BE N/A
Completed NCT04296513 - Diagnosis of Gastritis, H. Pylori Infection and Atrophic Gastritis in Dyspeptic Patients
Completed NCT01896310 - New Classification of Stomach Using Probe-based Confocal Laser Endomicroscopy N/A
Completed NCT01373125 - Is the Neosquamous Epithelium "Normal" Following Endoscopic Ablation of Dysplastic Barrett's Esophagus? N/A
Completed NCT03976739 - Study on the Effect of Bile Reflux on Gastric Cancer and Its Precancerous Lesions: a Cross-sectional Study.
Terminated NCT02788214 - Helicobacter Pylori Genome Project (HpGP)
Enrolling by invitation NCT03228095 - Volatiles in Breath and Headspace Analysis - Diagnostic Markers