AzTrials
AzTrials

GERDMaRSSNCT02637713

Management of Reflux After Sleeve Using Stretta

A study testing Stretta and Radiofrequency (RF) Energy to the LES (Stretta Procedure) in people with GERD and Morbid Obesity, run by Montefiore Medical Center at 13 sites in United States.

Terminated

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

Official record
Search all trials

Trial summary

Gastroesophageal reflux disease (GERD) is a frequently seen entity after sleeve gastrectomy. Management of GERD after sleeve is difficult given limited treatment modalities. Stretta is an endoscopic FDA approved device that improves symptoms of GERD, there is minimal information about its use on patients after sleeve. Read more about this study

Who is it for?
Ages 18 to 80 years
Conditions the study is for
GERD, Morbid Obesity
What is being tested?
Stretta and Radiofrequency (RF) Energy to the LES (Stretta Procedure)
Could I receive a placebo?
No, everyone receives an active treatment
How many people
5 participants
Where
13 sitesUnited States
Study dates
Mar 2016to May 2019
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

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 to 80 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Symptomatic reflux: (heartburn, chest discomfort, asthma/chronic cough, laryngitis, nocturnal aspiration or regurgitation)
  • On a PPI with GERD-related symptoms
  • On a PPI but like to discontinue them

Who cannot join

  • Age <18 or > 80
  • History of a severe psychiatric disorder: including suicidal ideation, or admission to a psychiatric institution.
  • Unable or unwilling to consent for an invasive procedure.
  • History of intestinal leak after surgery.
  • History of revisional bariatric surgery
  • Significant sleeve abnormalities such and twist or large fundus
Show all 19Show fewer
  • Hiatal hernia(>2cm)
  • Pregnancy
  • Inability to comply with study protocols and procedures
  • Esophageal stricture, Eosinophilic Esophagitis or Achalasia
  • Prior esophageal surgery or therapy for Barrett's Esophagus
  • Grades 3 or 4 esophagitis
  • Gastric or esophageal varices
  • History of obstruction of the small bowel or inflammatory bowel disease
  • Pacemaker or implanted cardiac defibrillator
  • Coagulopathy or use of anticoagulants
  • ASA classification >3
  • Scleroderma or other connective diseases
  • Use of immunosuppressive medications.

Trial locations and contacts

13 sites in 1 country.

13 sites in 1 country

United States13 sites
  • Brigham & Women's Hospital

    Boston, Massachusetts, 02115

  • University Hospitals Case Medical Center

    Cleveland, Ohio, 44106

  • Cleveland Clinic Health System

    Cleveland, Ohio, 44119

  • Ohio State University Wexner Medical Center

    Columbus, Ohio, 43210

  • Duke University Health System

    Durham, North Carolina, 27710

  • Penn State Milton S. Hershey Medical Center

    Hershey, Pennsylvania, 17033

  • Houston Methodist Hospital

    Houston, Texas, 77030

  • Memorial Hermann-Texas Medical Center

    Houston, Texas, 77030

  • Gastroenterology Clinic of Acadiana

    Lafayette, Louisiana, 70503

  • Cedars-Sinai Medical Center

    Los Angeles, California, 90048

  • Norwalk Hospital

    Norwalk, Connecticut, 06856

  • Stanford University Medical Center

    Stanford, California, 94305

  • Montefiore Medical Center

    The Bronx, New York, 10467

Other trials in United States

About this study

Official title: Radiofrequency Energy Delivery to the Lower Esophageal Sphincter (Stretta) in Sleeve Gastrectomy Patients With GERD

Gastroesophageal reflux disease (GERD) is a frequently seen entity after sleeve gastrectomy. Management of GERD after sleeve is difficult given limited treatment modalities. Stretta is an endoscopic FDA approved device that improves symptoms of GERD, there is minimal information about its use on patients after sleeve. This registry will attempt to get information regarding the treatment of reflux using Stretta after sleeve gastrectomy.

Read the detailed description

Gastroesophageal reflux disease (GERD) is a widely prevalent medical disorder in the United States with a spectrum of treatment options ranging from dietary modification, to various pharmacologic treatments, to an array of available surgical and endoscopic procedures. There is a well-described correlation between obesity and symptoms of GERD. The morbidly obese patients undergoing evaluation for bariatric surgery are to characterize any GERD-like symptoms as this will assist in directing surgical therapy. Generally, it is recommended that patients with severe GERD undergo Roux-en-Y gastric bypass(RYGB) rather than a sleeve gastrectomy (SG) as RYGB has proven to be the most effective surgical treatment for GERD in the morbidly obese patient. The number of bariatric procedures performed in the United States has increased significantly in the recent years. Out of all bariatric procedures SG is the most commonly performed in the United States, as it has proven to be a very safe procedure with excellent weight loss. However, the incidence of de novo GERD and the effect of SG on patients with preexisting GERD remain controversial. Although some authors report high incidence of de novo GERD and worsening of previous reflux symptoms, there is also data showing improvement of symptoms post SG. Management of GERD after SG poses an interesting challenge, as traditional invasive procedures like Nissen fundoplication are not available due to an altered gastric anatomy. The alternative is to perform a conversion to RYGB, which represents increased morbidity to patient and significant cost.

A large number of endoscopic procedures have been introduced in the past for the management of GERD as an alternative to the surgical anti-reflux procedures with various degrees of success. One of the few non-invasive methods for managing GERD that is still available on the market and widely used is Stretta. Stretta delivers Radio Frequency energy (RFe) to the LES resulting in increased LES pressure. In 2000, the FDA approved the Stretta system for treatment of GERD. Stretta allows an alternative for treatment in patients who are not willing or able to undergo surgery. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) published clinical practice guidelines that endorsed Stretta as an appropriate therapy for treatment of GERD in patients >18, with at least 6 months of symptoms partially or completely responsive to pharmacotherapy and who are unable or unwilling to undergo laparoscopic Nissen fundoplication. There are to date no studies evaluating the use of Stretta in management of patients with GERD symptoms after sleeve gastrectomy.

The investigators will study sleeve gastrectomy patients with GERD symptoms and if considered candidates for Stretta all patients will be enrolled in data collection cohort and followed prospectively with symptom questionnaire and quality of life scores for improvement of symptoms.

Conditions
GERD, Morbid Obesity
Being tested
Stretta, Radiofrequency (RF) Energy to the LES (Stretta Procedure)
Keywords
GERD, sleeve gastrectomy, reflux, morbidly obese
Medical subject headings
Gastroesophageal Reflux, Obesity, Morbid

What participants receive

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

  • StrettaDevice

    Stretta is an FDA approved device that delivers Radiofrequency energy delivery to the lower esophageal sphincter. It is approved for the management of GRED.

  • Radiofrequency (RF) Energy to the LES (Stretta Procedure)Procedure or surgery

    The Stretta procedure is performed endoscopically under moderate sedation or general anesthesia which uses radiofrequency (RF) energy applied to the lower esophagus over 14 minutes per FDA approved procedures.

Study groups in NCT02637713
Study groupRoleWhat they receive
Radiofrequency Energy to the Lower Esophageal Sphincter (LES)ExperimentalAll patients that have undergone sleeve gastrectomy as treatment for obesity that have developed severe reflux symptoms will be treated with Stretta (FDA approved device for the management of GERD) and evaluated prospectively for resolution/improvement of reflux symptoms.
Receives: Device: Stretta; Procedure: Radiofrequency (RF) Energy to the LES (Stretta Procedure)

What is being measured

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

  1. Number of Patients With Improved Symptoms Based on Reflux Symptom Index (RSI) Score

    RSI scores will be used to determine whether patients achieved at least a 50% reduction in symptoms as compared to baseline. Patients will be provided a 9-item questionnaire and asked to rate the score that best applies to their symptoms on a 6 point scale ranging from 0 = No Problem to 5 = Severe Problem.

    Measured: 6 months

  2. Number of Patients With Improved Symptoms Based on Reflux Severity Index (RSI) Score

    RSI scores will be used to determine whether patients achieved at least a 50% reduction in symptoms as compared to baseline. Patients will be provided a 9-item questionnaire and asked to rate the score that best applies to their symptoms on a 6 point scale ranging from 0 = No Problem to 5 = Severe Problem.

    Measured: 12 months

  3. Number of Patients With Improved Symptoms Based on Reflux Severity Index (RSI) Score

    RSI scores will be used to determine whether patients achieved at least a 50% reduction in symptoms as compared to baseline. Patients will be provided a 9-item questionnaire and asked to rate the score that best applies to their symptoms on a 6 point scale ranging from 0 = No Problem to 5 = Severe Problem.

    Measured: 24 months

  4. Number of Patients With Improved Symptoms Based on GERD Health Related Quality of Life (GERD-HRQL) Questionnaire Score

    GERD-HRQL scores will be used to determine whether patients achieved at least a 50% reduction in symptoms as compared to baseline. Patients will be provided a 15-item questionnaire and asked to rate the score that best applies to their symptoms on a 6 point scale ranging from 0 to 5 (overall range from 0-75) with higher scores indicative of worsening symptoms.

    Measured: 6 months

  5. Number of Patients With Improved Symptoms Based on GERD Health Related Quality of Life (GERD-HRQL) Questionnaire Score

    GERD-HRQL scores will be used to determine whether patients achieved at least a 50% reduction in symptoms as compared to baseline. Patients will be provided a 15-item questionnaire and asked to rate the score that best applies to their symptoms on a 6 point scale ranging from 0 to 5 (overall range from 0-75) with higher scores indicative of worsening symptoms.

    Measured: 12 months

  6. Number of Patients With Improved Symptoms Based on GERD Health Related Quality of Life (GERD-HRQL) Questionnaire Score

    GERD-HRQL scores will be used to determine whether patients achieved at least a 50% reduction in symptoms as compared to baseline. Patients will be provided a 15-item questionnaire and asked to rate the score that best applies to their symptoms on a 6 point scale ranging from 0 to 5 (overall range from 0-75) with higher scores indicative of worsening symptoms.

    Measured: 24 months

Secondary outcomes (11)
  1. Esophageal pH Levels

    All patients will have pH monitoring conducted at baseline pre-procedurally. The number of patients with abnormal pH levels will be tabulated. Bravo capsule monitoring will be used for evaluation.

    Measured: Baseline

  2. Esophageal pH Levels

    If esophageal pH levels at baseline are determined to have been abnormal, the number of patients with symptomatic GERD demonstrating an improvement in esophageal pH exposure following sleeve gastrectomy will be assessed. Bravo capsule monitoring will be used for evaluation.

    Measured: 6 months

  3. Esophageal pH Levels

    If esophageal pH levels at baseline are determined to have been abnormal, the number of patients with symptomatic GERD demonstrating an improvement in esophageal pH exposure following sleeve gastrectomy will be assessed. Bravo capsule monitoring will be used for evaluation.

    Measured: 12 months

  4. Use of Anti-reflux Medication

    The number of patients using anti-reflux medications will be tabulated.

    Measured: Baseline

  5. Cessation or Decreased Use of Anti-reflux Medication

    The number of patients who demonstrate a complete cessation or decrease in use of anti-reflux medications will be tabulated.

    Measured: 6 months

  6. Gastric Emptying Study

    A Gastric emptying study will be conducted for all patients at 1, 2, 3, and 4 hours. Patients with severe gastroparesis (>50% retention at 4 hours) will be excluded from study

    Measured: Baseline (up to 4 hours)

  7. Determination of Gastric Dysmotility as a Contributory Factor in GERD Following Sleeve Gastrectomy

    If gastric dysmotility is determined to have been abnormal at baseline, the gastric emptying study will be repeated at 6 months to evaluate Gastric Dysmotility will be evaluated as a contributory factor in GERD following sleeve gastrectomy.

    Measured: 6 months

  8. Determination of Gastric Dysmotility as a Contributory Factor in GERD Following Sleeve Gastrectomy

    If gastric dysmotility is determined to have been abnormal at baseline, the gastric emptying study will be repeated at 12 months to evaluate Gastric Dysmotility will be evaluated as a contributory factor in GERD following sleeve gastrectomy.

    Measured: 12 months

  9. EGD Abnormalities

    An EGD will be obtained for all patients at baseline. Biopsies of any suspicious lesions and any evidence of esophagitis will be obtained and scored in accordance with Los Angeles classification as either Grade A, Grade B, Grade C, or Grade D lesions with each grade denoting progressively more severe pathophysiology.

    Measured: Baseline

  10. EGD Abnormalities

    In those patients identified to have abnormal esophageal pathology at baseline, biopsies of any suspicious lesions and any evidence of esophagitis will be obtained and scored in accordance with Los Angeles classification as either Grade A, Grade B, Grade C, or Grade D lesions with each grade denoting progressively more severe pathology. The number of patients demonstrating objective histologic improvement or resolution of esophagitis will be determined.

    Measured: 6 months

  11. EGD Abnormalities

    In those patients identified to have abnormal esophageal pathology at baseline, biopsies of any suspicious lesions and any evidence of esophagitis will be obtained and scored in accordance with Los Angeles classification as either Grade A, Grade B, Grade C, or Grade D lesions with each grade denoting progressively more severe pathology. The number of patients demonstrating objective histologic improvement or resolution of esophagitis will be determined.

    Measured: 12 months

Timeline

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

  1. First posted22 Dec 2015 (estimated)
  2. Study startMar 2016
  3. Primary completionMay 2019
  4. Study completionMay 2019

Why it stopped: Low Accrual

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
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrolment
5 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02637713
Sponsor's protocol ID
2015-5661a
Acronym
MaRSS
Status last verified
Dec 2023
First submitted
16 Nov 2015
Last updated
23 Jan 2024
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
Yes

Questions about this trial

What is this clinical trial studying?

A study testing Stretta and Radiofrequency (RF) Energy to the LES (Stretta Procedure) in people with GERD and Morbid Obesity, run by Montefiore Medical Center at 13 sites in United States.

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 3 inclusion and 19 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 23 Jan 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 13 sites in United States. 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. 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?

Yes. Results are posted in the registry (first posted 8 May 2023). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

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?

Number of Patients With Improved Symptoms Based on Reflux Symptom Index (RSI) Score (time frame: 6 months). The study lists 6 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 23 Jan 2024.

Free account

Log in to keep searching

You’ve used your 3 free searches. AzTrials is free: log in or create a free account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in