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Adenomatous Polyposis ColicoldAPCNCT06435533

Cold Atmospheric Plasma for the Endoscopic Treatment of Duodenal Polyps in Patients With Familial Adenomatous Polyposis

A study testing low energy argonplasma coagulation in people with Adenomatous Polyposis Coli and Familial Adenomatous Polyposis, run by Universitätsklinikum Hamburg-Eppendorf at 1 site in Germany.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

The objective of this study is to investigate the feasibility for the treatment of precancerous peri-ampullary FAP polyps in the duodenum using low-thermal argonplasma. Read more about this study

Who is it for?
Ages 18 to 80 years
What is being tested?
low energy argonplasma coagulation
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
10 participants
Where
1 siteGermany
Study dates
6 Dec 2023to 2 Mar 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

  • confirmed FAP disease
  • duodenal polyposis with recommendation of a follow-up EGD in 12 months corresponding to stage III (7-8 points) according to Spigelman
  • presence of duodenal polyps < 10 mm
  • written Informed Consent

Who cannot join

  • presence of lesions that are suspicious of the presence of high-grade dysplasia or carcinoma
  • pregnancy or breastfeeding
  • severe general illnesses (permanent ASA (American Society of Anesthesiologists) III and IV) who do not prognostically benefit from follow-up, life expectancy < 1 year
  • severe coagulopathy
  • any visible state of duodenal surface that makes APC treatment impossible, e.g. inflammation, stricture, stenosis or scarring changes/scar areas

Trial locations and contacts

1 site in 1 country.

Thomas Rösch, Professor contact

+49407410 ext. 50098

t.roesch@uke.de

Germany1 site, 1 recruiting
  • University Hospital Hamburg-Eppendorf

    Hamburg, 20246

    Thomas Rösch, Professor, +49407410 ext. 50098, t.roesch@uke.de

    Tania Ruppenthal, +49407410 ext. 50089, t.ruppenthal@uke.de

    Recruiting

Other trials in Germany

About this study

The objective of this study is to investigate the feasibility for the treatment of precancerous peri-ampullary FAP polyps in the duodenum using low-thermal argonplasma.

Read the detailed description

Familial adenomatous polyposis (FAP) is an autosomal dominantly inherited disorder, which results from a germ line mutation in the APC (adenomatous polyposis coli) gene. FAP is characterized by the formation of very high number of colorectal adenomatous polyps which could cause the development of colorectal cancer in the 5th decade of life. After colon surgery patients are still at risk of developing upper GI cancer e.g. in the duodenum. Because of the continuing risk for the development of duodenal cancer, regular endoscopic surveillance is recommended for these patients.

In this study a new APC modality (Precise mode E1) applied for the remission of FAP polyps during routine endoscopic surveillance is suggested. Argonplasma coagulation (APC) is widely used for the ablation and coagulation of superficial lesions in the GI tract. The application of high thermal tissue destroying APC in the duodenum is challenging due to the anatomy of the duodenal wall which is thin and therefore susceptible to thermal damage.

The application of low-thermal argonplasma in the GI tract could be just as useful as it was suggested for the treatment of neoplastic tissue in gynecology. Low-thermal APC using Erbe Standard 3.2 mm FiAPC probe and Precise mode was successfully applied for the remission of cervical intraepithelial neoplasia. The formation of reactive oxygen and nitric oxide species has been discussed as trigger for the effect on neoplasia tissue of low-thermal argonplasma.

Regarding current knowledge this is the first application of this APC modality in the GI tract.

Being tested
low energy argonplasma coagulation
Keywords
Familial Adenomatous Polyposis, FAP, duodenal adenoma, argon plasma coagulation, Spigelman classification stage III
Medical subject headings
Adenomatous Polyposis Coli

What participants receive

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

  • low energy argonplasma coagulationDevice

    Also called cold APC

    see above

Study groups in NCT06435533
Study groupRoleWhat they receive
duodenal polyps <10 mmExperimentallow energy argonplasma coagulation
Receives: Device: low energy argonplasma coagulation

What is being measured

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

  1. polyp number

    Significant reduction in the number of duodenal polyps at the next follow-up appointment

    Measured: 12 months

  2. polyp size

    Significant reduction in the size of duodenal polyps at the next follow-up appointment

    Measured: 12 months

Secondary outcomes (25)
  1. acute haematemesis

    rate of acute adverse incidents: bleeding

    Measured: 24 hours

  2. acute hemoglobin drop

    rate of acute adverse incidents: Hb drop < 2g /dl (grammes per decilitre)

    Measured: 24 hours

  3. acute severe hemoglobin drop

    rate of acute adverse incidents: Hb drop = or > 2g /dl (grammes per decilitre)

    Measured: 24 hours

  4. blood transfusion

    rate of acute adverse incidents: Hb drop = or > 2g /dl (grammes per decilitre)

    Measured: 24 hours

  5. endoscopic hemostasis

    rate of acute adverse incidents: coagulation or clipping

    Measured: 24 hours

  6. treatment of perforation

    rate of acute adverse incidents: endoscopic clipping

    Measured: 24 hours

  7. need for surgical intervention

    rate of acute adverse incidents: bleeding or perforation which can not be handled by endoscopic treatment

    Measured: 24 hours

  8. acute abdominal pain

    rate of acute adverse incidents:pain

    Measured: 24 hours

  9. acute dysphagia

    rate of acute adverse incidents: stenosis

    Measured: 24 hours

  10. acute rise of temperature

    rate of acute adverse incidents: fever <38°C (degrees Centigrade)

    Measured: 24 hours

  11. EGD (esophago-gastro-duodenoscopy) time

    total EGD performing time

    Measured: during EGD; up to 45 minutes

  12. therapy time

    total ablation time in minutes

    Measured: up to 30 minutes

  13. abdominal pain

    abdominal pain assessed by patient survey

    Measured: 4 days

  14. nausea

    nausea assessed by patient survey

    Measured: 4 days

  15. feeling of fullness

    feeling of fullness assessed by patient survey

    Measured: 4 days

  16. emesis

    emesis assessed by patient survey

    Measured: 4 days

  17. signs of bleeding

    hematemesis or tar faeces assessed by patient survey

    Measured: 4 days

  18. fever

    fever >38°C

    Measured: 4 days

  19. need for physician help

    visits in doctor's office or hospital

    Measured: 4 days

  20. success rate

    Change in stage/number of points in Spigelman classification compared to the previous examination

    Measured: 12 months

  21. dysphagia

    dysphagia caused by duodenal stricture

    Measured: 12 months

  22. balloon dilatations

    need for endoscopic dilatation of strictured duodenum

    Measured: 12 months

  23. abdominal pain

    general abdominal pain assessed by patient survey

    Measured: 12 months

  24. postprandial pain

    postprandial abdominal pain assessed by patient survey

    Measured: 12 months

  25. emesis

    regurgitation due to duodenal strictures assessed by EGD

    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 posted30 May 2024
  2. Study start6 Dec 2023
  3. Primary completion30 Jan 2025 (estimated)
  4. Study completion2 Mar 2025 (estimated)

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
Model description
peri-ampullary FAP polyps of size smaller than 10 mm will be treated with low energy argonplasma coagulation
Masking
None (open label)
Enrolment
10 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06435533
Sponsor's protocol ID
2023-101193-BO-ff
Other IDs
2023
Acronym
coldAPC
Status last verified
May 2024
First submitted
14 Mar 2024
Last updated
30 May 2024
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Aelvoet AS, Buttitta F, Ricciardiello L, Dekker E. Management of familial adenomatous polyposis and MUTYH-associated polyposis; new insights. Best Pract Res Clin Gastroenterol. 2022 Jun-Aug;58-59:101793. doi: 10.1016/j.bpg.2022.101793. Epub 2022 Mar 16.

    PubMed 35988966
  • Half E, Bercovich D, Rozen P. Familial adenomatous polyposis. Orphanet J Rare Dis. 2009 Oct 12;4:22. doi: 10.1186/1750-1172-4-22.

    PubMed 19822006
  • Ghorbanoghli Z, Bastiaansen BA, Langers AM, Nagengast FM, Poley JW, Hardwick JC, Koornstra JJ, Sanduleanu S, de Vos Tot Nederveen Cappel WH, Witteman BJ, Morreau H, Dekker E, Vasen HF. Extracolonic cancer risk in Dutch patients with APC (adenomatous polyposis coli)-associated polyposis. J Med Genet. 2018 Jan;55(1):11-14. doi: 10.1136/jmedgenet-2017-104545. Epub 2017 May 10.

    PubMed 28490611
  • Bulow S, Bjork J, Christensen IJ, Fausa O, Jarvinen H, Moesgaard F, Vasen HF; DAF Study Group. Duodenal adenomatosis in familial adenomatous polyposis. Gut. 2004 Mar;53(3):381-6. doi: 10.1136/gut.2003.027771.

    PubMed 14960520
  • Kadmon M, Tandara A, Herfarth C. Duodenal adenomatosis in familial adenomatous polyposis coli. A review of the literature and results from the Heidelberg Polyposis Register. Int J Colorectal Dis. 2001 Apr;16(2):63-75. doi: 10.1007/s003840100290.

    PubMed 11355321
  • Bjork J, Akerbrant H, Iselius L, Bergman A, Engwall Y, Wahlstrom J, Martinsson T, Nordling M, Hultcrantz R. Periampullary adenomas and adenocarcinomas in familial adenomatous polyposis: cumulative risks and APC gene mutations. Gastroenterology. 2001 Nov;121(5):1127-35. doi: 10.1053/gast.2001.28707.

    PubMed 11677205
  • van Leerdam ME, Roos VH, van Hooft JE, Dekker E, Jover R, Kaminski MF, Latchford A, Neumann H, Pellise M, Saurin JC, Tanis PJ, Wagner A, Balaguer F, Ricciardiello L. Endoscopic management of polyposis syndromes: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2019 Sep;51(9):877-895. doi: 10.1055/a-0965-0605. Epub 2019 Jul 23.

    PubMed 31342472
  • Spigelman AD, Williams CB, Talbot IC, Domizio P, Phillips RK. Upper gastrointestinal cancer in patients with familial adenomatous polyposis. Lancet. 1989 Sep 30;2(8666):783-5. doi: 10.1016/s0140-6736(89)90840-4.

    PubMed 2571019
  • Manner H. Thermal ablative therapies in the gastrointestinal tract. Curr Opin Gastroenterol. 2023 Sep 1;39(5):370-374. doi: 10.1097/MOG.0000000000000954. Epub 2023 Jun 22.

    PubMed 37389449
  • Manner H. Argon plasma coagulation therapy. Curr Opin Gastroenterol. 2008 Sep;24(5):612-6. doi: 10.1097/MOG.0b013e32830bf825.

    PubMed 19122503
  • Martusevich AK, Surovegina AV, Bocharin IV, Nazarov VV, Minenko IA, Artamonov MY. Cold Argon Athmospheric Plasma for Biomedicine: Biological Effects, Applications and Possibilities. Antioxidants (Basel). 2022 Jun 27;11(7):1262. doi: 10.3390/antiox11071262.

    PubMed 35883753
  • Marzi J, Stope MB, Henes M, Koch A, Wenzel T, Holl M, Layland SL, Neis F, Bosmuller H, Ruoff F, Templin M, Kramer B, Staebler A, Barz J, Carvajal Berrio DA, Enderle M, Loskill PM, Brucker SY, Schenke-Layland K, Weiss M. Noninvasive Physical Plasma as Innovative and Tissue-Preserving Therapy for Women Positive for Cervical Intraepithelial Neoplasia. Cancers (Basel). 2022 Apr 12;14(8):1933. doi: 10.3390/cancers14081933.

    PubMed 35454839
  • Grund KE, Storek D, Farin G. Endoscopic argon plasma coagulation (APC) first clinical experiences in flexible endoscopy. Endosc Surg Allied Technol. 1994 Feb;2(1):42-6.

    PubMed 8081915
  • Karamanolis G, Triantafyllou K, Tsiamoulos Z, Polymeros D, Kalli T, Misailidis N, Ladas SD. Argon plasma coagulation has a long-lasting therapeutic effect in patients with chronic radiation proctitis. Endoscopy. 2009 Jun;41(6):529-31. doi: 10.1055/s-0029-1214726. Epub 2009 May 13.

    PubMed 19440956
  • Peng M, Guo X, Yi F, Shao X, Wang L, Wu Y, Wang C, Zhu M, Bian O, Ibrahim M, Chawla S, Qi X. Endoscopic treatment for gastric antral vascular ectasia. Ther Adv Chronic Dis. 2021 Aug 12;12:20406223211039696. doi: 10.1177/20406223211039696. eCollection 2021.

    PubMed 34408826

Questions about this trial

What is this clinical trial studying?

A study testing low energy argonplasma coagulation in people with Adenomatous Polyposis Coli and Familial Adenomatous Polyposis, run by Universitätsklinikum Hamburg-Eppendorf at 1 site 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 5 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: status not confirmed, as of the sponsor's last update on 30 May 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site 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?

Contact Thomas Rösch, Professor (+49407410 ext. 50098, t.roesch@uke.de), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

polyp number (time frame: 12 months). The study lists 2 primary outcomes in all. 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 NCT06435533, which also lists 24 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 30 May 2024.

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