Primary Sclerosing Cholangitis Clinical Trial
Official title:
Multicenter Randomized Trial Comparing Short-term Stenting Versus Balloon Dilatation for Dominant Strictures in Primary Sclerosing Cholangitis
Primary sclerosing cholangitis (PSC) is a chronic inflammatory disease of the biliary tract of unknown origin. Around 50% of patients develop during their disease course narrowing of the main bile duct with corresponding increase in symptoms such as itching, jaundice and abdominal pain. These narrowings can be treated by balloon dilatation or temporary insertion of a plastic endoprosthesis. However, it is not known which of these two therapeutic modalities is best. This study aims to compare both techniques in order to determine which is best in terms of postponing recurrence of the narrowing, safety and costs.
Rationale:
Primary sclerosing cholangitis is a chronic progressive fibro-obliterative disease of the
biliary tree leading to biliary cirrhosis. During its course, dominant strictures occur in
approximately 50% of patients. These can be accompanied by lead worsening of symptoms and
jaundice and are an indication for endoscopic treatment. The best form of treatment, either
balloon dilatation or short-term stent placement, has never been formally investigated.
Objective:
Primary:
To compare the efficacy of single session balloon dilatation versus short-term stent
placement in non-advanced PSC patients with regard to re-intervention free recurrence rate
at two years.
Secondary:
To compare the short term efficacy of single balloon dilatation versus short-term stenting
with regard to improvement of cholestatic symptoms, biochemical cholestasis, and quality of
life in non-endstage PSC patients at three months; to compare the safety of single balloon
dilatation session versus short-term stenting in non advanced PSC patients during two years.
Study design: This is a multicenter, open-label, randomized intervention study.
Study population:
Non-advanced primary sclerosing cholangitis subjects with progression of cholestatic
complaints from the outpatient population of the seven participating centres.
Main study parameters/endpoints:
1. Difference in re-intervention free survival time between both groups at two years.
2. Change in semi-quantitative scoring of cholestatic symptoms (pruritus, right upper
quadrant pain, fatigue) from baseline at three months.
3. Change in total bilirubin, alkaline phosphatase, and yGT from baseline at 3 months.
4. Safety: adverse events, clinical laboratory values, vital signs.
Nature and extent of the burden and risks associated with participation, benefit and group
relatedness:
Currently, both interventions belong to standard patient care armamentarium. Burden for the
patient exists in slightly more regular follow-up visits for two years (three-monthly
instead of every 3-4 months) to their treating centre. ERCP is associated with a low
mortality (<0.5 %) and acceptable morbidity (overall 5%). Most dreaded complications are
severe post-ERCP pancreatitis (<2%) and suppurative cholangitis (<2%). From the available
retrospective literature data the incidence of these complications does not seem to differ
between the two treatment modalities. ERCP will only be performed when there is a clearcut
clinical indication anyway.
;
Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
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