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Submucosal Tumor of StomachSTREETNCT04913077

Submucosal Tumor Removal by Endoscopic Excision Therapy

A study testing removal of submucosal gastric tumor preferably by Full Thickness Resection Device (FTRD) in people with Submucosal Tumor of Stomach, run by Universitätsklinikum Hamburg-Eppendorf at 3 sites in Germany.

Suspended

Paused. Enrolment is on hold for now and may resume.

Official record
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Trial summary

Smaller submucosal tumors (SMT) in the stomach are usually seen as an incidental finding during a gastroscopy, although current diagnostics usually do not clearly indicate what type of tumor it is. In summary, there is no good evidence for dealing with SMT. Read more about this study

Who is it for?
Ages 18 to 80 years
Conditions the study is for
Submucosal Tumor of Stomach
What is being tested?
removal of submucosal gastric tumor preferably by Full Thickness Resection Device (FTRD)
Could I receive a placebo?
No, everyone receives an active treatment
How many people
200 participants
Where
3 sitesGermany
Study dates
10 Mar 2020to Feb 2025
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 to 80 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patients with endoscopically diagnosed and endosonographically confirmed submucosal tumors of 0.5 to 2 cm in the stomach without definitive histology / cytology
  • Initial diagnosis less than 2 years ago
  • No contraindication to endoscopic resection
  • Patient's informed consent

Who cannot join

  • Tumor size > 2 cm
  • Tumors with proven / suspected malignancy for which oncologically no endoscopic resection should be performed, i.e. for which oncological or surgical therapy is planned
  • SMT known > 2 Years
  • Patients with severe general illnesses (limited operability) or malignancies
  • Clotting disorders
  • Pregnancy

Trial locations and contacts

3 sites in 1 country.

Germany3 sites
  • University Hospital Freiburg

    Freiburg im Breisgau, 79106

  • University Hospital Hamburg Eppendorf

    Hamburg, 20246

  • University Hospital Marburg

    Marburg, 35039

Other trials in Germany

About this study

Official title: Prospective One-armed Observational Study of Full-thickness Resection of Small Hypoechoic Submucosal Gastric Tumors (≤2 cm)

Smaller submucosal tumors (SMT) in the stomach are usually seen as an incidental finding during a gastroscopy, although current diagnostics usually do not clearly indicate what type of tumor it is. In summary, there is no good evidence for dealing with SMT. In this study, an endoscopic full-thickness resection, primarily with the FTRD device, is to be offered to all patients with gastric SMT without a confirmed histology seen in a certain period of time . Patients who do not want to take advantage of this are included in a systematic follow-up program.

The investigators hope to learn about the rate of so-called GIST tumors and other histologies, as well as the rate of change in the follow-up group.

Also, study contents will be accuracy of endosonographic imaging and puncture in comparison with resection histology, technical feasibility and histological completeness of the FTRD- based endoscopic (full-wall) resection option, complications of such a resection (secondary bleeding and dehiscences), and patient preferences with standardized information.

Read the detailed description

Smaller submucous tumors in the stomach are usually seen as a random finding in gastroscopies and present a diagnostic dilemma to the doctor and patient:

type specification is usually unclear whether it is an absolutely benign (without degeneration potential) or a malignant or prone tumor (usually gastrointestinal stromal tumor, GIST). However, this is crucial for further management.

In endosonographic imaging there are only approximate values in the differential diagnosis between GIST and non-GIST, the endoscopic biopsy is too superficial, and the hit rate of endosonographic pin puncture is limited, and in most studies is less than 70% Therefore, one can only make assumptions and create a risk profile from imaging and tumor size (limit size 3 cm, partly also 2 cm). Both follow-up recommendations (rather no GIST) and laparoscopic surgical removal (proven or probable/possible GIST) are not rarely without clear preference, especially for smaller tumors.

For these indications, a simple endoscopic removal option comparable to the polypectomy in the colon (where no histological type diagnosis is made before) does not exist.

Previous studies are usually subject to bias in several directions:

  1. The frequency of GIST tumors among submucous tumors/lesions (SMT) in the stomach is unclear. Gastroenterological series always contain smaller GIST tumors, but are reported almost exclusively from clinics. The rate of these tumors in the overall collective of patients seen in the field of (mostly established) gastroenterologists is thus completely unclear. Surgical or oncological series have usually included more aggressive tumors consisting mainly or exclusively of GIST tumors, therefore do not allow epidemiological conclusions.
  2. If no surgery is performed (and thus a definitive histology is forced), only information from follow-up examinations remains. Previous follow-up studies show the dilemma of insufficient differential diagnosis of lesions by endosonography and (endosonographic or other) biopsy, which usually have insufficient accuracy. In addition, the follow-up time in the studies hardly extends beyond 2 years. The "gastroenterological gut instinct" that these small lesions are not dangerous may be true, but is not proven.
Being tested
removal of submucosal gastric tumor preferably by Full Thickness Resection Device (FTRD)
Keywords
Submucosal Tumor of Stomach, GIST, FTRD

What participants receive

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

  • removal of submucosal gastric tumor preferably by Full Thickness Resection Device (FTRD)Other

    Also called Endoscopic submucosal dissection (ESD)

    FTRD (Ovesco company) in tumors up to 10 mm and predominantly intraluminal growth directly by sucking into the cap, at 10-20 mm and/or intramural/extramural growth by prior circumcision and lateral preparation, so that the lesions can be better pulled into the cap. The procedure depends on the endosonographic extent of the findings. The lesions are pulled into the cap with grippers and other instruments and, if necessary, with a snare and then resected with FTRD

Study groups in NCT04913077
Study groupRoleWhat they receive
Removal of submucosal gastric tumor preferably by Full Thickness Resection Device (FTRD)OtherFTRD (Ovesco company) in tumors up to 10 mm and predominantly intraluminal growth directly by sucking into the cap, at 10-20 mm and/or intramural/extramural growth by prior circumcision and lateral preparation, so that the lesions can be better pulled into the cap. The procedure depends on the endosonographic extent of the findings. The lesions are pulled into the cap with grippers and other instruments and, if necessary, with a snare and then resected with FTRD
Receives: Other: removal of submucosal gastric tumor preferably by Full Thickness Resection Device (FTRD)

What is being measured

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

  1. Rate of GIST tumors

    Rate of GIST tumors in a preferably unselected patient cohort of small submucous gastric tumors in which histology is not known

    Measured: through study completion, approximately 2 years

Secondary outcomes (10)
  1. Technical success

    Technical success rate (R0/R1 resection) of the chosen resection technique

    Measured: through study completion, approximately 2 years

  2. Complication rate

    Complication rate of the chosen resection technique

    Measured: through study completion, approximately 2 years

  3. influencing factors on the GIST rate: tumor size

    Influence of tumor size on the GIST rate

    Measured: through study completion, approximately 2 years

  4. Influencing factors on the GIST rate: position of tumor

    Influence of tumor position in the stomach

    Measured: through study completion, approximately 2 years

  5. Influencing factors on the GIST rate: endoscopic ultrasound image

    endoscopic ultrasound image with pattern and position in the wall

    Measured: through study completion, approximately 2 years

  6. Influencing factors on the GIST rate: patient's age

    Age of patients

    Measured: through study completion, approximately 2 years

  7. Influencing factors on the GIST rate: patient's gender

    gender of patients

    Measured: through study completion, approximately 2 years

  8. Influencing factors on the GIST rate: anamnesis

    anamnesis including initial diagnosis

    Measured: through study completion, approximately 2 years

  9. Patient's preferred approach

    Patient preferences for removal (consent rate for the study) versus follow-up

    Measured: through study completion, approximately 2 years

  10. data for cost-benefit calculation

    Establishment of a date base for a cost-benefit calculation comparing follow-up vs. removal

    Measured: through study completion, approximately 2 years

Timeline

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

  1. First posted4 Jun 2021
  2. Study start10 Mar 2020
  3. Primary completionNov 2024 (estimated)
  4. Study completionFeb 2025 (estimated)

Why it stopped: interim 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
Diagnosis
Allocation
Not applicable
Intervention model
Single group
Model description
Submucosal gastric Tumors up to 2 centimeters of size
Masking
None (open label)
Enrolment
200 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04913077
Sponsor's protocol ID
PV7129
Acronym
STREET
Status last verified
Mar 2024
First submitted
23 Jan 2021
Last updated
19 Mar 2024
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Cai MY, Martin Carreras-Presas F, Zhou PH. Endoscopic full-thickness resection for gastrointestinal submucosal tumors. Dig Endosc. 2018 Apr;30 Suppl 1:17-24. doi: 10.1111/den.13003.

    PubMed 29658639
  • Akahoshi K, Oya M, Koga T, Shiratsuchi Y. Current clinical management of gastrointestinal stromal tumor. World J Gastroenterol. 2018 Jul 14;24(26):2806-2817. doi: 10.3748/wjg.v24.i26.2806.

    PubMed 30018476
  • Cazacu IM, Luzuriaga Chavez AA, Nogueras Gonzalez GM, Saftoiu A, Bhutani MS. Malignant Transformation of Ectopic Pancreas. Dig Dis Sci. 2019 Mar;64(3):655-668. doi: 10.1007/s10620-018-5366-z. Epub 2018 Nov 10.

    PubMed 30415408
  • Standards of Practice Committee; Faulx AL, Kothari S, Acosta RD, Agrawal D, Bruining DH, Chandrasekhara V, Eloubeidi MA, Fanelli RD, Gurudu SR, Khashab MA, Lightdale JR, Muthusamy VR, Shaukat A, Qumseya BJ, Wang A, Wani SB, Yang J, DeWitt JM. The role of endoscopy in subepithelial lesions of the GI tract. Gastrointest Endosc. 2017 Jun;85(6):1117-1132. doi: 10.1016/j.gie.2017.02.022. Epub 2017 Apr 3. No abstract available.

    PubMed 28385194
  • Kida M, Kawaguchi Y, Miyata E, Hasegawa R, Kaneko T, Yamauchi H, Koizumi S, Okuwaki K, Miyazawa S, Iwai T, Kikuchi H, Watanabe M, Imaizumi H, Koizumi W. Endoscopic ultrasonography diagnosis of subepithelial lesions. Dig Endosc. 2017 May;29(4):431-443. doi: 10.1111/den.12854. Epub 2017 Apr 6.

    PubMed 28258621
  • Kim SY, Kim KO. Management of gastric subepithelial tumors: The role of endoscopy. World J Gastrointest Endosc. 2016 Jun 10;8(11):418-24. doi: 10.4253/wjge.v8.i11.418.

    PubMed 27298713
  • Kim SY, Kim KO. Endoscopic Treatment of Subepithelial Tumors. Clin Endosc. 2018 Jan;51(1):19-27. doi: 10.5946/ce.2018.020. Epub 2018 Jan 31.

    PubMed 29397653
  • Lim TW, Choi CW, Kang DH, Kim HW, Park SB, Kim SJ. Endoscopic ultrasound without tissue acquisition has poor accuracy for diagnosing gastric subepithelial tumors. Medicine (Baltimore). 2016 Nov;95(44):e5246. doi: 10.1097/MD.0000000000005246.

    PubMed 27858880
  • Marcella C, Shi RH, Sarwar S. Clinical Overview of GIST and Its Latest Management by Endoscopic Resection in Upper GI: A Literature Review. Gastroenterol Res Pract. 2018 Oct 31;2018:6864256. doi: 10.1155/2018/6864256. eCollection 2018.

    PubMed 30515204
  • Moon JS. Role of Endoscopic Ultrasonography in Guiding Treatment Plans for Upper Gastrointestinal Subepithelial Tumors. Clin Endosc. 2016 May;49(3):220-5. doi: 10.5946/ce.2016.047. Epub 2016 May 20.

    PubMed 27209643
  • Bruno M, Carucci P, Repici A, Pellicano R, Mezzabotta L, Goss M, Magnolia MR, Saracco GM, Rizzetto M, De Angelis C. The natural history of gastrointestinal subepithelial tumors arising from muscularis propria: an endoscopic ultrasound survey. J Clin Gastroenterol. 2009 Oct;43(9):821-5. doi: 10.1097/MCG.0b013e31818f50b8.

    PubMed 19349904
  • Kim MY, Jung HY, Choi KD, Song HJ, Lee JH, Kim DH, Choi KS, Lee GH, Kim JH. Natural history of asymptomatic small gastric subepithelial tumors. J Clin Gastroenterol. 2011 Apr;45(4):330-6. doi: 10.1097/MCG.0b013e318206474e.

    PubMed 21278578
  • Kushnir VM, Keswani RN, Hollander TG, Kohlmeier C, Mullady DK, Azar RR, Murad FM, Komanduri S, Edmundowicz SA, Early DS. Compliance with surveillance recommendations for foregut subepithelial tumors is poor: results of a prospective multicenter study. Gastrointest Endosc. 2015;81(6):1378-84. doi: 10.1016/j.gie.2014.11.013. Epub 2015 Feb 7.

    PubMed 25660977

Questions about this trial

What is this clinical trial studying?

A study testing removal of submucosal gastric tumor preferably by Full Thickness Resection Device (FTRD) in people with Submucosal Tumor of Stomach, run by Universitätsklinikum Hamburg-Eppendorf at 3 sites in Germany.

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 6 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: paused, as of the sponsor's last update on 19 Mar 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 3 sites in Germany. 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?

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?

Rate of GIST tumors (time frame: through study completion, approximately 2 years). 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 NCT04913077, which also lists 13 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 19 Mar 2024.

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