The Effect of Satiety Gut Hormone Modulation on Appetitive Drive After Upper Gastrointestinal Surgery

NCT ID: NCT02381249

Last Updated: 2023-11-27

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

COMPLETED

Clinical Phase

NA

Total Enrollment

40 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-03-31

Study Completion Date

2018-03-31

Brief Summary

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Improvements to treatment strategies for patients with cancers of the upper gastrointestinal tract have produced a large population of people who remain free from cancer recurrence in the long term following treatment.

Surgery is the cornerstone of treatment for patients with these cancers, but while surgical removal of the tumour may offer the best chance of cure, these are major operations associated with specific long term complications. Weight loss and poor nutrition are common problems among patients who attain long-term cancer remission and cure after surgery. The mechanisms underlying these problems are not well understood and therefore treatment options are limited.

Our research has demonstrated increased levels of chemical messengers (gut hormones) released from the gastrointestinal tract after meals in patients who have previously undergone this type of surgery. These chemical messengers play a role in controlling appetite and interest in food, and increased levels after surgery may reduce interest in eating. Understanding the role of gut hormones in the control of appetite may allow us to use certain medications to block gut hormones and hence increase appetite, allowing patients to eat more and regain weight, preventing nutritional problems after surgery.

In this study, the investigators aim to determine whether exaggerated gut hormone secretion causes reduced appetite and interest in food after surgery. The information gained from this study may help us to develop treatments for patients with weight loss and nutritional problems after surgery.

Detailed Description

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Conditions

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Esophageal Neoplasms Stomach Neoplasms Weight Loss Malnutrition Pancreatic Neoplasms Duodenal Neoplasms

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Primary Study Purpose

BASIC_SCIENCE

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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Esophagectomy

Double-blind single dose octreotide-placebo crossover

Group Type EXPERIMENTAL

Octreotide

Intervention Type DRUG

Single dose 100mcg octreotide acetate (1mL), subcutaneously to the lower abdomen

Placebo

Intervention Type DRUG

Single dose 0.9% saline (1mL), subcutaneously to the lower abdomen

Gastrectomy

Double-blind single dose octreotide-placebo crossover

Group Type EXPERIMENTAL

Octreotide

Intervention Type DRUG

Single dose 100mcg octreotide acetate (1mL), subcutaneously to the lower abdomen

Placebo

Intervention Type DRUG

Single dose 0.9% saline (1mL), subcutaneously to the lower abdomen

Unoperated healthy control

Double-blind single dose octreotide-placebo crossover

Group Type ACTIVE_COMPARATOR

Octreotide

Intervention Type DRUG

Single dose 100mcg octreotide acetate (1mL), subcutaneously to the lower abdomen

Placebo

Intervention Type DRUG

Single dose 0.9% saline (1mL), subcutaneously to the lower abdomen

Pancreaticoduodenectomy

Double-blind single dose octreotide-placebo crossover

Group Type EXPERIMENTAL

Octreotide

Intervention Type DRUG

Single dose 100mcg octreotide acetate (1mL), subcutaneously to the lower abdomen

Placebo

Intervention Type DRUG

Single dose 0.9% saline (1mL), subcutaneously to the lower abdomen

Interventions

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Octreotide

Single dose 100mcg octreotide acetate (1mL), subcutaneously to the lower abdomen

Intervention Type DRUG

Placebo

Single dose 0.9% saline (1mL), subcutaneously to the lower abdomen

Intervention Type DRUG

Other Intervention Names

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Sandostatin

Eligibility Criteria

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Inclusion Criteria

1. Surgical procedure: Two-stage, three-stage or transhiatal esophagectomy with gastric conduit reconstruction and pyloroplasty, total gastrectomy with Roux-en-Y reconstruction, pancreaticoduodenectomy, or matched healthy unoperated control subjects
2. Disease-free at least one year post-resection

Exclusion Criteria

1. Pregnancy, breastfeeding
2. Significant and persistent chemoradiotherapy and/or surgical complication
3. Other previous upper gastrointestinal surgery
4. Unwell or unable to eat
5. Other disease or medications which may affect satiety gut hormone responses
6. Active and significant psychiatric illness including substance misuse
7. Cognitive or communication issues or any factors affecting capacity to consent to participation
8. History of significant food allergy, certain dietary restrictions
9. Confirmed or suspected residual or recurrent disease after surgery, second primary malignancy
10. Requiring adjuvant chemotherapy
11. Contraindication to octreotide administration
12. History of eating disorder
Minimum Eligible Age

18 Years

Maximum Eligible Age

100 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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University College Dublin

OTHER

Sponsor Role collaborator

University of Dublin, Trinity College

OTHER

Sponsor Role collaborator

Göteborg University

OTHER

Sponsor Role collaborator

St. James's Hospital, Ireland

OTHER

Sponsor Role lead

Responsible Party

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Dr Jessie A Elliott

Surgical Research Fellow

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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John V Reynolds, MCh, FRCS

Role: PRINCIPAL_INVESTIGATOR

Department of Surgery, St. James's Hospital

Locations

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Wellcome Trust-Health Research Board Clinical Research Facility, St. James's Hospital

Dublin, , Ireland

Site Status

Gastrosurgical Laboratory, Sahlgrenska Academy, University of Gothenburg

Gothenburg, , Sweden

Site Status

Countries

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Ireland Sweden

References

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Miras AD, Jackson RN, Jackson SN, Goldstone AP, Olbers T, Hackenberg T, Spector AC, le Roux CW. Gastric bypass surgery for obesity decreases the reward value of a sweet-fat stimulus as assessed in a progressive ratio task. Am J Clin Nutr. 2012 Sep;96(3):467-73. doi: 10.3945/ajcn.112.036921. Epub 2012 Jul 25.

Reference Type BACKGROUND
PMID: 22836034 (View on PubMed)

HODOS W. Progressive ratio as a measure of reward strength. Science. 1961 Sep 29;134(3483):943-4. doi: 10.1126/science.134.3483.943.

Reference Type BACKGROUND
PMID: 13714876 (View on PubMed)

Miholic J, Orskov C, Holst JJ, Kotzerke J, Pichlmayr R. Postprandial release of glucagon-like peptide-1, pancreatic glucagon, and insulin after esophageal resection. Digestion. 1993;54(2):73-8. doi: 10.1159/000201016.

Reference Type BACKGROUND
PMID: 8319842 (View on PubMed)

Haverkort EB, Binnekade JM, Busch OR, van Berge Henegouwen MI, de Haan RJ, Gouma DJ. Presence and persistence of nutrition-related symptoms during the first year following esophagectomy with gastric tube reconstruction in clinically disease-free patients. World J Surg. 2010 Dec;34(12):2844-52. doi: 10.1007/s00268-010-0786-8.

Reference Type BACKGROUND
PMID: 20842361 (View on PubMed)

Koizumi M, Hosoya Y, Dezaki K, Yada T, Hosoda H, Kangawa K, Nagai H, Lefor AT, Sata N, Yasuda Y. Postoperative weight loss does not resolve after esophagectomy despite normal serum ghrelin levels. Ann Thorac Surg. 2011 Apr;91(4):1032-7. doi: 10.1016/j.athoracsur.2010.11.072.

Reference Type BACKGROUND
PMID: 21440118 (View on PubMed)

le Roux CW, Aylwin SJ, Batterham RL, Borg CM, Coyle F, Prasad V, Shurey S, Ghatei MA, Patel AG, Bloom SR. Gut hormone profiles following bariatric surgery favor an anorectic state, facilitate weight loss, and improve metabolic parameters. Ann Surg. 2006 Jan;243(1):108-14. doi: 10.1097/01.sla.0000183349.16877.84.

Reference Type BACKGROUND
PMID: 16371744 (View on PubMed)

Elliott JA, Docherty NG, Haag J, Eckhardt HG, Ravi N, Reynolds JV, le Roux CW. Attenuation of satiety gut hormones increases appetitive behavior after curative esophagectomy for esophageal cancer. Am J Clin Nutr. 2019 Feb 1;109(2):335-344. doi: 10.1093/ajcn/nqy324.

Reference Type DERIVED
PMID: 30722001 (View on PubMed)

Related Links

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http://www.sjhcrf.ie

Wellcome Trust-HRB Clinical Research Facility

http://www.ucd.ie/conway/

Conway Institute of Biomolecular and Biomedical Research

Other Identifiers

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CRFSJ 0057

Identifier Type: -

Identifier Source: org_study_id