The Effect of Hepatic Vein Pressure Gradient(HVPG)-Guided Therapy in Cirrhotic Patients With Esophagogastric Varices

NCT ID: NCT02638415

Last Updated: 2015-12-23

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

500 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-12-31

Study Completion Date

2018-09-30

Brief Summary

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The purpose of the study is to compare the effect of HVPG-guided individualized therapy and non-HVPG guided traditional therapy in cirrhotic patients for secondary prophylaxis.

Detailed Description

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The study is a randomized controlled trial of Zelen-design. Patients randomly enter two treatment groups: 1) the HVPG group and 2) the non-HVPG group. Treatment allocation is by block randomization with an equal number for both groups. The results are concealed in opaque envelopes.After randomization, patients will have a second chance to decide if they want to stay in the current group.Patients can switch to another group according to their will. If they are in the HVPG group,they will receive HVPG measurement before treatment. If they are in the non-HVPG group, they start treatment without HVPG measurement and receive endoscopic treatment plus Carvedilol.The mortality rate and rebleeding rate will be analyzed.

Conditions

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Gastroesophageal Varices Cirrhosis

Keywords

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HVPG

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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HVPG group

HVPG-guided therapy

Group Type EXPERIMENTAL

HVPG-guided therapy

Intervention Type PROCEDURE

Patients with an HVPG over 20mmHg will be suggested to receive transjugular intrahepatic portocaval shunt (TIPS) or surgical shunt operation.

Patients with an HVPG between 16 and 20mmHg can choose either endoscopic treatment or TIPS according their willingness and indication.

Patients with an HVPG below 16mmHg will be treated by endoscopy plus Carvedilol, until endoscopic treatment fails.

Carvedilol

Intervention Type DRUG

Patients in HVPG group with HVPG below 16mmHg and all patients in non-HVPG group will take Carvedilol 12.5mg/d if they have no contraindications.

non-HVPG group

routine therapy

Group Type OTHER

routine therapy

Intervention Type OTHER

Patients start treatment without HVPG measurement and receive endoscopic therapy plus Carvedilol.

Carvedilol

Intervention Type DRUG

Patients in HVPG group with HVPG below 16mmHg and all patients in non-HVPG group will take Carvedilol 12.5mg/d if they have no contraindications.

Interventions

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HVPG-guided therapy

Patients with an HVPG over 20mmHg will be suggested to receive transjugular intrahepatic portocaval shunt (TIPS) or surgical shunt operation.

Patients with an HVPG between 16 and 20mmHg can choose either endoscopic treatment or TIPS according their willingness and indication.

Patients with an HVPG below 16mmHg will be treated by endoscopy plus Carvedilol, until endoscopic treatment fails.

Intervention Type PROCEDURE

routine therapy

Patients start treatment without HVPG measurement and receive endoscopic therapy plus Carvedilol.

Intervention Type OTHER

Carvedilol

Patients in HVPG group with HVPG below 16mmHg and all patients in non-HVPG group will take Carvedilol 12.5mg/d if they have no contraindications.

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Patients with cirrhosis diagnosed by histology, radiological evidence of cirrhosis, and endoscopic evidence of varices;
* Patients with a previous history of variceal hemorrhage;
* Patients admitted to Zhongshan Hospital and other 6 tertiary centers in Shanghai from Dec 1, 2015 to Sep 31,2018

Exclusion Criteria

* Patients already taken secondary prophylactic treatment including endoscopic, pharmacological, surgical and interventional therapies;
* Patients with severe systemic diseases such as chronic heart failure or chronic renal failure that will have impact on survival;
* Patients in pregnancy and lactation;
* Patients already diagnosed with hepatic cellular carcinoma or other malignant tumors;
* Patients with contraindication to treatment of endoscopy, surgery and TIPS: severe coagulation defects, allergic to contrast medium used in TIPS, hepatic encephalopathy, spontaneous bacterial peritonitis;
* Patients with conditions that will influence the accuracy of HVPG measurement: Cavernous transformation of portal vein, diffused portal vein thrombosis, severe shunt;
* Patients refuse to give consent to the study.
Minimum Eligible Age

18 Years

Maximum Eligible Age

70 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine

OTHER

Sponsor Role collaborator

Shanghai Public Health Clinical Center

OTHER_GOV

Sponsor Role collaborator

ShuGuang Hospital

OTHER

Sponsor Role collaborator

Xinhua Hospital, Shanghai Jiao Tong University School of Medicine

OTHER

Sponsor Role collaborator

Shanghai Pudong New Area Gongli Hospital

OTHER

Sponsor Role collaborator

Eastern Hepatobiliary Surgery Hospital

OTHER

Sponsor Role collaborator

Shanghai Zhongshan Hospital

OTHER

Sponsor Role lead

Responsible Party

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Shiyao Chen

Director of department of Gastroenterology, Zhongshan Hospital

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Shiyao Chen, Professor

Role: PRINCIPAL_INVESTIGATOR

Shanghai Zhongshan Hospital

Locations

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Shanghai Zhongshan Hospital

Shanghai, Shanghai Municipality, China

Site Status RECRUITING

Countries

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China

Central Contacts

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Shiyao Chen, Professor

Role: CONTACT

Phone: 86-13601767310

Email: [email protected]

Facility Contacts

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Yichao Wei, Doctor

Role: primary

Other Identifiers

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CSY-WYC02-2015

Identifier Type: -

Identifier Source: org_study_id