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Postoperative IleusCaCoNCT02510911

Does Caffeine Reduce Postoperative Bowel Paralysis After Elective Colectomy?

A study testing Caffeine (100 mg), Caffeine (200 mg) and corn starch (250 mg approx.) in people with Postoperative Ileus and Laparoscopic Colectomy Without Stoma Formation, run by Thomas Steffen at 2 sites in Switzerland.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

Postoperative bowel paralysis is common after abdominal operations, including colectomy. As a result, hospitalization may be prolonged leading to increased cost. A recent randomized controlled trial from the University of Heidelberg showed that consumption of regular black coffee after colectomy is safe and associated… Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Caffeine (100 mg), Caffeine (200 mg) and corn starch (250 mg approx.)
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
60 participants
Where
2 sitesSwitzerland
Study dates
Aug 2015to 22 Dec 2020
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patients scheduled for elective laparoscopic colectomy (right or left hemicolectomy, segmental resection, extended hemicolectomy, sigmoid resection, upper rectum (anastomosis higher than 7 cm ab ano))
  • There will be no upper age limit. If elderly patients are considered fit for surgery, they will be included in the study.
  • Informed consent
  • Application of epidural analgesia

Who cannot join

  • Participation in another concurrent interventional trial
  • Need for a stoma (colostomy or ileostomy) or reversal of a stoma, if the patient had a complete bowel obstruction
  • Known hypersensitivity or allergy to caffeine/coffee
  • Expected lack of compliance
  • American Society of Anesthesiologists (ASA) Physical Status Score of IV or V
  • Impaired mental state or language problems
Show all 16Show fewer
  • Alcoholism or drug abuse
  • Previous extensive abdominal surgery
  • Inflammatory bowel disease
  • Clinically significant cardiac arrhythmia
  • Cardiac insufficiency
  • Pregnancy, lactation, or childbearing potential without using adequate contraception
  • Intake of opioid analgesics, or steroids >5mg/d for ≥7 days before surgery
  • Under anti-depressive medication
  • Liver cirrhosis or compromised liver function (MELD score >15)
  • Emergency procedure

Trial locations and contacts

2 sites in 1 country.

Switzerland2 sites
  • Department of General, Visceral, Endocrine and Transplantation Surgery, Cantonal Hospital St. Gallen

    Rorschach, 9400

  • Department of General, Visceral, Endocrine and Transplantation Surgery, Cantonal Hospital St. Gallen

    Sankt Gallen, 9007

Other trials in Switzerland

About this study

Official title: Does Caffeine Reduce Postoperative Bowel Paralysis After Elective Colectomy? - A Randomized, Placebo-controlled Trial

Postoperative bowel paralysis is common after abdominal operations, including colectomy. As a result, hospitalization may be prolonged leading to increased cost. A recent randomized controlled trial from the University of Heidelberg showed that consumption of regular black coffee after colectomy is safe and associated with a significantly faster resumption of intestinal motility (Müller 2012). The mechanism how coffee stimulates intestinal motility is unknown but caffeine seems to be the most likely stimulating agent.

Thus, this trial addresses the question: Does caffeine reduce postoperative bowel paralysis after elective laparoscopic colectomy?

Read more

Patients after laparoscopic colectomy will receive either 100 mg caffeine, 200 mg caffeine, or 250mg corn starch (placebo) 3 times daily in identically looking gelatin capsules.

The study is a randomized, controlled trial, with blinding of physicians, patients and nursing stuff (evaluating the endpoints).

Primary endpoint will be the time to first bowel movement.

Being tested
Caffeine (100 mg), Caffeine (200 mg), corn starch (250 mg approx.), Radiopaque marker
Keywords
colectomy, laparoscopy, caffeine
Medical subject headings
Colorectal Neoplasms, Diverticulitis

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Caffeine (100 mg)Drug

    Also called coffeinum, methyltheobromine, 1,3,7-trimethyl-3,7-dihydro-1H-purin-2,4-dion, CAS No: 56-08-2

    Patients after laparoscopic colectomy will receive 3 times daily capsules with 100 mg caffeine together with the meals.

    First capsule will be taken on the evening of surgery if surgery was completed before 1 pm, otherwise the first capsule will be taken on the morning of the next day.

    Treatment consists of 10 capsules and will be stopped after the first solid bowel movement.

  • Caffeine (200 mg)Drug

    Also called coffeinum, methyltheobromine, 1,3,7-trimethyl-3,7-dihydro-1H-purin-2,4-dion, CAS No: 56-08-2

    Patients after laparoscopic colectomy will receive 3 times daily capsules with 200 mg caffeine together with the meals.

    First capsule will be taken on the evening of surgery if surgery was completed before 1 pm, otherwise the first capsule will be taken on the morning of the next day.

    Treatment consists of 10 capsules and will be stopped after the first solid bowel movement.

  • corn starch (250 mg approx.)Drug

    Also called Amylum maydis

    Patients after laparoscopic colectomy will receive 3 times daily capsules with 250 mg corn starch together with the meals.

    First capsule will be taken on the evening of surgery if surgery was completed before 1 pm, otherwise the first capsule will be taken on the morning of the next day.

    Treatment consists of 10 capsules and will be stopped after the first solid bowel movement.

  • Radiopaque markerOther

    Also called Colon Transit, PZN 3351272, GTIN Code 7629999004153

    On the morning of the first, second and third day after surgery patients will take 1 capsule each day with radiopaque markers .

    On day 4 after surgery an abdominal X-ray will be performed to localize the markers.

    Each gelatin capsule contains 10 markers consisting of polyurethane encapsulated barium sulfate (40%).

Study groups in NCT02510911
Study groupRoleWhat they receive
Caffeine (100 mg)ExperimentalVerum 1 with 100 mg caffeine
Receives: Drug: Caffeine (100 mg); Other: Radiopaque marker
Caffeine (200 mg)ExperimentalVerum 2 with 200 mg caffeine
Receives: Drug: Caffeine (200 mg); Other: Radiopaque marker
corn starch (250 mg approx.)Placebo comparatorapprox. 250 mg corn starch as placebo
Receives: Drug: corn starch (250 mg approx.); Other: Radiopaque marker

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Time to first bowel movement

    Time from end of surgery (time of closing suture) until patient's first bowel movement (passage of stool) in hours.

    A patient is considered to have met the primary endpoint when he or she had first tolerated food (recovery of upper GI function) and experienced a bowel movement for the first time (recovery of lower GI function).

    Measured: 7 days

Secondary outcomes (18)
  1. Time to first flatus

    Time from end of surgery until patient's first flatus in hours. The passage of flatus will be determined by questioning the patient; the passage of a bowel movement will be determined by reference to nursing records or by the clinical judgment of the investigator or designee following questioning the patient.

    Measured: 7 days

  2. Time to tolerance of solid food

    Time from end of surgery until patient tolerates intake of solid food in hours. Tolerance of food is defined as the first time the patient is able to eat solid food (any food re-quiring chewing) without vomiting or significant nausea within 4 h after the meal, and without reversion to only enteral fluids.

    Measured: 7 days

  3. Postoperative vomiting events

    Number of times patient has to vomit.

    Measured: 7 days

  4. Colonic passage time

    On day 1, 2 and 3 after surgery patients take one capsule with radioopaque markers. On day 4 location and count of markers is determined by X-ray imaging and the colonic passage time is determined (Metcalf 1987).

    Measured: 4 days

  5. Actual postoperative hospital stay

    Number of days from surgery until actual discharge.

    Measured: 30 days

  6. Theoretical postoperative hospital stay

    Days from surgery until patient would be fit for release. Often patients stay longer in hospital than clinically required. Thus, evaluation of theoretical hospital stay.

    A patient is fit for release if:

    • there had been bowel movement
    • solid food is tolerated
    • no serious pain
    • unproblematic mobilisation
    • surgical wound shows no sign of inflammation, or wound can be treated well in an outpatient setting
    • normal inflammatory markers (≤135 mg/l C-reactive protein (CRP), ≤9 10⁹/l white blood cell count)

    Measured: 30 days

  7. Daily doses of analgetics

    Amount, type, and time of application of analgetics will be obtained from medical and nursing records.

    Measured: 30 days

  8. Postoperative pain

    evaluated on the numeric rating scale (0 - 10, steps of 1)

    Measured: 7 days

  9. Postoperative mobilization

    Scoring:

    • 0: 24 h in bed
    • 1: Out of bed only to go to bathroom
    • 2: Out of bed on free will

    Measured: 7 days

  10. Overall fluid intake

    all fluids in ml per day

    Measured: 7 days

  11. Blood pressure

    3 times daily

    Measured: 7 days

  12. Pulse

    3 times daily (or more often if required)

    Measured: 7 days

  13. Intensive care

    number of days in intensive care unit

    Measured: 14 days

  14. Well-being

    well-being evaluating on day 2 and 4 after surgery using the Basle mental state scale as well as 5 additional items to evaluate the effects of caffeine. (Hobi 1985, Hobi 1989)

    Measured: 4 days

  15. Sleep behaviour

    Leeds Sleep Evaluation Questionnaire (LSEQ) on day 2 and 4 after surgery. (Parrott 1986)

    Measured: 4 days

  16. Sleeping habits

    Questionnaire evaluating duration and deepness of sleep.

    Measured: 4 days

  17. Satisfaction with surgery

    Questionnaire on day 4 about satisfaction of treatment

    Measured: 4 days

  18. Consumption of sleep inducing drugs

    amount and type of sleep inducing drugs

    Measured: 7 days

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted29 Jul 2015 (estimated)
  2. Study startAug 2015
  3. Primary completionAug 2020
  4. Study completion22 Dec 2020

Why it stopped: lack of effect at interims analysis

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
60 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02510911
Sponsor's protocol ID
CaCo, Chir201401
Acronym
CaCo
Status last verified
Aug 2021
First submitted
27 Jul 2015
Last updated
4 Aug 2021
Results posted
No
Data monitoring committee
Yes
Individual data sharing
No

Publications

  • Muller SA, Rahbari NN, Schneider F, Warschkow R, Simon T, von Frankenberg M, Bork U, Weitz J, Schmied BM, Buchler MW. Randomized clinical trial on the effect of coffee on postoperative ileus following elective colectomy. Br J Surg. 2012 Nov;99(11):1530-8. doi: 10.1002/bjs.8885. Epub 2012 Sep 14.

    PubMed 22987303
  • Metcalf AM, Phillips SF, Zinsmeister AR, MacCarty RL, Beart RW, Wolff BG. Simplified assessment of segmental colonic transit. Gastroenterology. 1987 Jan;92(1):40-7. doi: 10.1016/0016-5085(87)90837-7.

    PubMed 3023168
  • Hobi V, Gerhard U, Gutzwiller F. [A report on experiences using Goldberg's GHQ (General Health Questionnaire)]. Schweiz Rundsch Med Prax. 1989 Feb 28;78(9):219-25. German.

    PubMed 2928619
  • Hobi V. Basler Befindlichkeits-Skala. Ein Self-Rating zur Verlaufsmessung der Befindlichkeit. Manual. 1 ed. Weinheim: Beltz Test GmbH, 1985.

  • Parrott AC, Hindmarch I. The Leeds Sleep Evaluation Questionnaire in psychopharmacological investigations - a review. Psychopharmacology (Berl). 1980;71(2):173-9. doi: 10.1007/BF00434408.

    PubMed 6777817
  • Abbassi F, Muller SA, Steffen T, Schmied BM, Warschkow R, Beutner U, Tarantino I. Caffeine for intestinal transit after laparoscopic colectomy: randomized clinical trial (CaCo trial). Br J Surg. 2022 Nov 22;109(12):1216-1223. doi: 10.1093/bjs/znac265.

    PubMed 35909263
  • Kruse C, Muller SA, Warschkow R, Luthi C, Brunner W, Marti L, Sulz MC, Schmied BM, Tarantino I, Beutner U. Does caffeine reduce postoperative bowel paralysis after elective laparoscopic colectomy? (CaCo trial): study protocol for a randomized controlled trial. Trials. 2016 Apr 4;17:186. doi: 10.1186/s13063-016-1297-1.

    PubMed 27044596

Questions about this trial

What is this clinical trial studying?

A study testing Caffeine (100 mg), Caffeine (200 mg) and corn starch (250 mg approx.) in people with Postoperative Ileus and Laparoscopic Colectomy Without Stoma Formation, run by Thomas Steffen at 2 sites in Switzerland.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 16 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: stopped early, as of the sponsor's last update on 4 Aug 2021. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in Switzerland. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study was stopped early (reason given: lack of effect at interims analysis). Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Time to first bowel movement (time frame: 7 days). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02510911, which also lists 7 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 4 Aug 2021.

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