Effect of Mosapride on Postoperative Ileus in Patients Undergoing Colorectal Surgery

NCT ID: NCT02056405

Last Updated: 2015-12-17

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

PHASE4

Total Enrollment

90 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-12-31

Study Completion Date

2017-12-31

Brief Summary

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Postoperative Ileus is defined as the transient postoperative functional inhibition of propulsive bowel activity. The ethiology of this process can best be described as multifactorial. In its pathogenesis different mechanisms are involved such as hormones and neuropeptides, inflammation, narcotics and the Autonomic nervous system. Is one of the most common causes of prolonged hospital stays after abdominal surgery, thereby increasing health-care resource utilization. More importantly, it causes patient discomfort in the form of nausea, vomiting, and stomach cramps. It has a variable duration but is usually solved in 3 to 4 days. Prolonged Ileus is associated with postoperative complications like an increase on urinary and pulmonary infections, profound venous thrombosis and wound-site complications.

Mosapride is a prokinetic agent that acts as a selective serotonin agonist (5- HT4) that facilitates acetylcholine release from the intrinsic plexus. This accelerates gastric emptying and propulsive peristaltic movements on the lower intestines. Mosapride has no action over the central nervous system therefore the lesser side effects like cardiac arrhythmias and extrapyramidal symptoms. For being a safer drug we chose it to be the center of our research.

Two randomized controlled trials studied Mosapride concluding it shortens PI after colorectal surgery. However these trials took place on specific populations (Orientals) with less than 50 patients and only one of them included laparoscopic treatment specifically. Also the end point of these studies didn't consider the impact of PI over hospital stay or costs to the health system.

We therefore decided to conduct a prospective randomized study in patients undergoing laparoscopic colorectal surgery for colon cancer. The patients will be randomized to receive treatment or placebo after surgery. With this study we intend to prove that patients treated with mosapride immediately after surgery suffer from shorter postoperative ileus with earlier oral intake and shorter hospital stay.

The primary aim of the trial is to assess the effectiveness of the use of Mosapride in shortening the duration of the Postoperative ileus in patients undergoing colorectal laparoscopic surgery. The trial hypothesis is that the standardized use of Mosapride immediately after colorectal laparoscopic surgery is safe and accelerates the recovery of propulsive bowel activity, thereby shortening postoperative ileus and hospital stay.

Detailed Description

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Methods. Design. Design A randomized controlled trial, triple blind with placebo. Study population Patients undergoing laparoscopic colorectal surgery. Italian Hospital of Buenos Aires. Argentina.

Inclusion and exclusion criteria

Participants will be eligible provided they are at least 18 years of age and under 85, are about to undergo colonic or upper rectum surgery with the diagnose of cancer o malignant polyp. People will be excluded if:

* They refuse to participate from the trial or the process of informed consent
* Have known allergies or hypersensitivity to Mosapride or lactose (used for placebo)
* Patients with ascites, hepatic metastases or carcinomatosis
* Patients who cannot receive Non-steroidal anti-inflammatory drugs
* Pregnancy or women at a fertile age who do not use double contraceptive agents
* Patients with conversion to laparotomy
* Patients with a Rectal tumor beneath 11 cm requiring low or ultralow rectal resection
* Patients with an stoma or who underwent simultaneous resection of other organs

Conditions

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Postoperative Ileus

Keywords

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Postoperative Ileus Mosapride Colorectal laparoscopic surgery Prolonged postoperative ileus

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

TRIPLE

Participants Caregivers Investigators

Study Groups

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Placebo

Placebo arm: intake of placebo (Lactose). 1 pill of the same characteristics as Mosapride every 8 hs with 30 ml tap water. This will begin on postoperative day 1 until discharge from Hospital or unacceptable toxicity develops.

Group Type PLACEBO_COMPARATOR

Placebo

Intervention Type DRUG

1 pill of the same characteristics as Mosapride every 8 hs with 30 ml tap water. This will begin on postoperative day 1 until discharge from Hospital or unacceptable toxicity develops.

Mosapride

Mosapride arm: intake of active drug (Mosapride). 15 mg per day divided into 3 oral intakes of 5 mg each (1 pill of Mosapride every 8 hs with 30 ml tap water). This treatment will begin on postoperative day 1 until discharge from Hospital or unacceptable toxicity develops.

Group Type ACTIVE_COMPARATOR

Mosapride

Intervention Type DRUG

15 mg per day divided into 3 oral intakes of 5 mg each (1 pill of Mosapride every 8 hs with 30 ml tap water). This treatment will begin on postoperative day 1 until discharge from Hospital or unacceptable toxicity develops.

Interventions

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Mosapride

15 mg per day divided into 3 oral intakes of 5 mg each (1 pill of Mosapride every 8 hs with 30 ml tap water). This treatment will begin on postoperative day 1 until discharge from Hospital or unacceptable toxicity develops.

Intervention Type DRUG

Placebo

1 pill of the same characteristics as Mosapride every 8 hs with 30 ml tap water. This will begin on postoperative day 1 until discharge from Hospital or unacceptable toxicity develops.

Intervention Type DRUG

Other Intervention Names

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Mosar Lactose

Eligibility Criteria

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Inclusion Criteria

* 18 to 85 years old
* Underwent colonic or upper rectum laparoscopic surgery with diagnose of cancer or malignant polyp
* Were operated on Italian Hospital of Buenos Aires

Exclusion Criteria

* They refuse to participate from the trial or the process of informed consent
* Have known allergies or hypersensitivity to Mosapride or lactose (used for placebo)
* Patients with ascites, hepatic metastases or carcinomatosis
* Patients who cannot receive Non-steroidal anti-inflammatory drugs
* Pregnancy or women at a fertile age who do not use double contraceptive agents
* Patients with conversion to laparotomy
* Patients with a Rectal tumor beneath 11 cm requiring low or ultralow rectal resection
* Patients with an derivative stoma or who underwent simultaneous resection of other organs
Minimum Eligible Age

18 Years

Maximum Eligible Age

85 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Hospital Italiano de Buenos Aires

OTHER

Sponsor Role lead

Responsible Party

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Diego Hernan Giunta, MD

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Carlos A Vaccaro, MD

Role: STUDY_DIRECTOR

Hospital Italiano de Buenos Aires

Locations

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Italian Hospital of Buenos Aires

Buenos Aires, State Capital, Argentina

Site Status RECRUITING

Countries

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Argentina

Central Contacts

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Virginia M Cano Busnelli, MD

Role: CONTACT

Phone: 54 11 66128852

Email: [email protected]

Natalia L Gomez, MD

Role: CONTACT

Phone: 54 11 68364732

Email: [email protected]

References

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Toyomasu Y, Mochiki E, Morita H, Ogawa A, Yanai M, Ohno T, Fujii T, Tsutsumi S, Asao T, Kuwano H. Mosapride citrate improves postoperative ileus of patients with colectomy. J Gastrointest Surg. 2011 Aug;15(8):1361-7. doi: 10.1007/s11605-011-1567-x. Epub 2011 May 24.

Reference Type BACKGROUND
PMID: 21607794 (View on PubMed)

Narita K, Tsunoda A, Takenaka K, Watanabe M, Nakao K, Kusano M. Effect of mosapride on recovery of intestinal motility after hand-assisted laparoscopic colectomy for carcinoma. Dis Colon Rectum. 2008 Nov;51(11):1692-5. doi: 10.1007/s10350-008-9407-0. Epub 2008 Jun 27.

Reference Type BACKGROUND
PMID: 18584249 (View on PubMed)

Seta ML, Kale-Pradhan PB. Efficacy of metoclopramide in postoperative ileus after exploratory laparotomy. Pharmacotherapy. 2001 Oct;21(10):1181-6. doi: 10.1592/phco.21.15.1181.33888.

Reference Type BACKGROUND
PMID: 11601663 (View on PubMed)

Davidson ED, Hersh T, Brinner RA, Barnett SM, Boyle LP. The effects of metoclopramide on postoperative ileus. A randomized double-blind study. Ann Surg. 1979 Jul;190(1):27-30. doi: 10.1097/00000658-197907000-00006.

Reference Type BACKGROUND
PMID: 582360 (View on PubMed)

Furness JB, Costa M. Adynamic ileus, its pathogenesis and treatment. Med Biol. 1974 Apr;52(2):82-9. No abstract available.

Reference Type BACKGROUND
PMID: 4365867 (View on PubMed)

Jepsen S, Klaerke A, Nielsen PH, Simonsen O. Negative effect of Metoclopramide in postoperative adynamic ileus. A prospective, randomized, double blind study. Br J Surg. 1986 Apr;73(4):290-1. doi: 10.1002/bjs.1800730414.

Reference Type BACKGROUND
PMID: 3516299 (View on PubMed)

Tollesson PO, Cassuto J, Rimback G, Faxen A, Bergman L, Mattsson E. Treatment of postoperative paralytic ileus with cisapride. Scand J Gastroenterol. 1991 May;26(5):477-82. doi: 10.3109/00365529108998569.

Reference Type BACKGROUND
PMID: 1871540 (View on PubMed)

Brown TA, McDonald J, Williard W. A prospective, randomized, double-blinded, placebo-controlled trial of cisapride after colorectal surgery. Am J Surg. 1999 May;177(5):399-401. doi: 10.1016/s0002-9610(99)00071-9.

Reference Type BACKGROUND
PMID: 10365879 (View on PubMed)

Other Identifiers

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2104

Identifier Type: -

Identifier Source: org_study_id