Prospective Pilot Study for the Evaluation of Endoscopic Sleeve Gastroplasty With Endomina® for the Treatment of Obesity in Liver Transplant Candidates

NCT05760235 | Recruiting

• 1 other identifier: 4903
• Study Type: interventional
• Target: 24
• Locations: 1 country
• Sites: 1

Brief Summary

The goal of this pilot prospective interventional study is to evaluate the efficacy of endoscopic sleeve gastroplasty (ESG) in allowing obese subjects with the need of liver transplantation to reduce their BMI in order to enter the waiting list (BMI (≥35 kg/m2). The main question\[s\] it aims to answer are:

• Is the procedure effective in reducing BMI to the target level in 12 months?
• Which is the effect on weight loss, quality of life and obesity-related comorbidities? Participants will undergo ESG as per standard clinical practice and followed up to 12 months before transplantation and for 12 months after transplantation

Conditions

Liver Transplantation; Obesity; Bariatric Surgery

Outcome Measures

Primary Outcomes (1)

• Transplant list inclusion

  number of patients who achieve a BMI \< 35 kg/m² within 12 months post-ESG, allowing them to be included in the transplant list

  12 months

Study Arms (1)

Liver transplant obese candidates

EXPERIMENTAL

Subjects with an indication to liver transplantation that are not listed because of a high BMI according to the policy of the transplant Centre (cut-off 35 kg/m2)

Procedure: Endoscopic sleeve gastroplasty (ESG)

Interventions

Endoscopic sleeve gastroplasty (ESG) PROCEDURE

ESG will be performed under general anaesthesia with orotracheal intubation. The Endomina® suturing system (EndoTools Therapeutics S.A., Gosselies, Belgium) mounted on a single channel endoscope will be used. This system allows to obtain full thickness gastric sutures through the gastric wall of the gastric body, leaving the antrum and the gastric fundus free15. The procedure will be performed with the patient in supine position. Carbon dioxide will be blown to stretch the gastric lumen. An initial endoscopic evaluation will be performed immediately to confirm the absence of any contraindication to ESG before suturing. The ESG starts with the reduction of the gastric body, suturing from distal to proximal and starting from the notch of the angulus and ending at the level of the fundus. 4-8 full thickness stitches will be placed, with 2 passes per stitch.

Liver transplant obese candidates

Eligibility Criteria

• Age: 18 Years - 70 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Adult patients (i.e., age between 18 and 70 years).
• BMI ≥ 35 kg/m²;
• Subjects with an indication to liver transplantation that are not listed because of a high BMI according to the policy of the transplant Centre (cut-off 35 kg/m2);
• Signed informed consent.

You may not qualify if:

• Clinically significant portal hypertension at upper endoscopy: F3 or F1/F2 with red signs oesophageal varices, gastric varices or severe hypertensive gastropathy;
• Upper gastro-intestinal bleeding (gastric or esophageal) in the previous six months;
• CHILD C class;
• Clinically or ultrasound-detected ascites in the 15 days before the procedure. Only mild ascitic effusion in the pelvis will be accepted;
• Spontaneous bacterial peritonitis in the previous 6 months;
• Hepatocellular carcinoma with extra hepatic spread;
• Previous stomach, oesophagus or duodenum surgery;
• Technical non-feasibility in the opinion of the endoscopist;
• Clinical signs of active infection;
• Unstable cardiac disease or chronic heart failure;
• Platelet count less than 70.000;
• International Normalized Ratio ≥ 1,5;
• Concomitant unstoppable anticoagulant or anti platelet therapy, except for low dose aspirin (≤ 100 mg);
• Acute liver failure;
• Easy to bleed during diagnostic endoscopy;

Sponsors & Collaborators

• Fondazione Policlinico Universitario Agostino Gemelli IRCCS: lead

Study Sites (1)

Fondazione Policlinico Gemelli IRCCS

Rome, Lazio, 00168, Italy

RECRUITING

MeSH Terms

Conditions

Obesity

Condition Hierarchy (Ancestors)

Overweight; Overnutrition; Nutrition Disorders; Nutritional and Metabolic Diseases; Body Weight; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Central Study Contacts

Giuseppe Marrone

CONTACT

+390630157779; giuseppe.marrone@policlinicogemelli.it

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: February 27, 2023
• First Posted: March 8, 2023
• Study Start: October 13, 2022
• Primary Completion: October 1, 2024
• Study Completion: November 1, 2024
• Last Updated: March 5, 2024

Record last verified: 2024-02

Locations

IT (1)