An Investigation of the EndoStim® Lower Esophageal Sphincter (LES) Stimulation System for the Treatment of Reflux

NCT ID: NCT02749071

Last Updated: 2019-10-18

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

TERMINATED

Clinical Phase

NA

Total Enrollment

161 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-05-31

Study Completion Date

2019-10-31

Brief Summary

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The purpose of this investigation is to demonstrate the safety and effectiveness of Lower Esophageal Sphincter (LES) Stimulation System in treating gastroesophageal reflux disease (GERD). This investigation is a multicenter, randomized, double-blind, sham-controlled study. After the implant procedure, subjects will be randomized to either the Treatment Group (immediate stimulation) or Control Group (delayed stimulation) for six months followed by an additional open-label phase in which all subjects will receive electrical stimulation. Subjects continue on stimulation treatment in an extended open-label follow-up phase through 5 years post-stimulation.

Detailed Description

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The purpose of this investigation is to demonstrate the safety and effectiveness of the EndoStim® Lower Esophageal Sphincter (LES) Stimulation System in the treatment of subjects with gastroesophageal reflux disease (GERD). This investigation is a multicenter, randomized, double-blind, sham-controlled clinical investigation. After the implant procedure, subjects will be randomized to either the Treatment Group (immediate stimulation) or Control Group (delayed stimulation) for a 6-month, double-blind phase followed by an additional open-label treatment phase in which all subjects will receive electrical stimulation therapy for a total of 12 months. Subjects continue on stimulation treatment and an extended open-label follow-up phase includes an 18 month post-stimulation phone interview followed by annual visits through 5 years post-stimulation.

Conditions

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Gastroesophageal Reflux Disease (GERD) Reflux, Gastroesophageal Gastroesophageal Reflux Acid Reflux

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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Control Group

This group will undergo laparoscopic implantation surgery. The device will not be activated: Sham EndoStim stimulation for first six months of study. It will be activated at the Month 6 visit and provide lower esophageal stimulation from Month 6 thru end of study.

Group Type SHAM_COMPARATOR

Laparoscopic implantation surgery

Intervention Type PROCEDURE

Laparoscopic surgery to implant the pulse generator and bipolar lead.

EndoStim stimulation from Month 6 thru end of study

Intervention Type DEVICE

Lower esophageal stimulation

Sham EndoStim stimulation for first six months of study

Intervention Type DEVICE

EndoStim device remains "off" (no stimulation delivered)

Treatment Group

The group will undergo laparoscopic implantation surgery. The device will be activated two weeks post-implantation and the subject will receive EndoStim stimulation for first six months of study and continue with EndoStim stimulation from Month 6 thru end of study.

Group Type EXPERIMENTAL

Laparoscopic implantation surgery

Intervention Type PROCEDURE

Laparoscopic surgery to implant the pulse generator and bipolar lead.

EndoStim stimulation for first six months of study

Intervention Type DEVICE

Lower esophageal stimulation

EndoStim stimulation from Month 6 thru end of study

Intervention Type DEVICE

Lower esophageal stimulation

Interventions

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Laparoscopic implantation surgery

Laparoscopic surgery to implant the pulse generator and bipolar lead.

Intervention Type PROCEDURE

EndoStim stimulation for first six months of study

Lower esophageal stimulation

Intervention Type DEVICE

EndoStim stimulation from Month 6 thru end of study

Lower esophageal stimulation

Intervention Type DEVICE

Sham EndoStim stimulation for first six months of study

EndoStim device remains "off" (no stimulation delivered)

Intervention Type DEVICE

Other Intervention Names

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EndoStim Implantable Pulse Generator (IPG) lower esophageal stimulation EndoStim Implantable Pulse Generator (IPG) lower esophageal stimulation

Eligibility Criteria

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Inclusion Criteria

1. Able and willing to provide written informed consent
2. Able and willing to comply with required study procedures and follow-up schedule
3. 22 - 75 years of age at the time of informed consent
4. Documented symptoms of gastroesophageal reflux disease (GERD) for longer than 6 months (regurgitation and/or heartburn which is defined as burning epigastric or substernal pain which responds to acid neutralization or suppression) which requires daily use of proton pump inhibitors (PPIs) or other anti-reflux drug therapy, who continue to have symptoms despite maximum medical therapy or are "intolerant" -severe side-effects (e.g. anaphylaxis or severe allergic reaction, recurrent C. difficile, severe hypomagnesaemia) to one PPI or mild/moderate side effect (e.g. nausea, vomiting, diarrhea or abdominal pain) to at least 2 PPIs of different chemical classes.
5. Symptomatic improvement on PPI therapy demonstrated by a composite GERD-health-related quality of life (HRQL) score of ≥20 off PPI, and a ≥10 point improvement on PPI compared to the off PPI composite GERD-HRQL score. Patients who meet the definition above of PPI intolerant are not required to have ≥10 point improvement. The on-PPI score to satisfy this criterion will be the score from the GERD-HRQL assessment completed after resuming PPIs following the Baseline visit.
6. Excessive lower esophageal acid exposure during pH monitoring (defined as distal esophageal pH \< 4 for \> 6.0% of the monitoring time) performed after at least 5 days off of PPIs and at least 2 days off of H2 blockers. At least 18 hour of esophageal pH recording will be considered adequate and inclusion will be based on the day (at least 18 hours of valid data) with the highest acid exposure percentage time.
7. Esophagitis ≤ Grade B (Los Angeles (LA) classification) as measured by upper endoscopy off PPI and H2 blockers for 10-14 days
8. Esophageal body contraction amplitude \> 30 mmHg for \> 30% of swallows and \> 30% peristaltic contractions on HRM or ≥ 30% peristaltic contractions with DCI \>450.
9. Suitable surgical candidate able to undergo general anesthesia and laparoscopic surgery

Exclusion Criteria

1. Previous EndoStim LES System implant and/or implant attempt
2. Previous surgery involving the gastroesophageal junction or the lead implant site, such as a Nissen fundoplication
3. Previous endoscopic intervention for the treatment of GERD and/or Barrett's esophagus
4. Hiatal hernia larger than 3 cm as determined by endoscopy
5. History of gastroparesis
6. Any non-GERD esophageal motility disorders that in the opinion of investigator precludes an anti-reflux procedure
7. History of or known esophageal stricture or significant esophageal anatomic abnormalities (obstructive lesions, etc.)
8. Barrett's esophagus or any grade of dysplasia
9. Documented history of esophagitis Grade C or D (LA Classification)
10. History of suspected or confirmed esophageal or gastric cancer
11. Esophageal or gastric varices
12. Symptoms of dysphagia more than once per week every week within the last 3 months
13. Unable to tolerate withdrawal from H2 Blockers or PPI medications
14. Suspected or known allergies to titanium, platinum, iridium, stainless steel, silicone, epoxy, or nylon
15. Body mass index (BMI) \> 35 kg/m2
16. Any significant multisystem diseases
17. Autoimmune or a connective tissue disorder (scleroderma, dermatomyositis, Calcinosis-Raynaud's-Esophagus Sclerodactyly Syndrome (CREST), Sjogren's Syndrome, Sharp's Syndrome, etc.) requiring therapy in the preceding 2 years
18. Type 1 diabetes mellitus or uncontrolled Type 2 diabetes mellitus (T2DM) defined as HbA1c \> 9.5 in the previous 6 months or at screening/baseline
19. Significant cardiac arrhythmia or ectopy or significant cardiovascular disease (i.e. unstable angina pectoris, hemodynamically significant valvular disease, severe congestive heart failure), or any cardiac therapeutic intervention within the last 6 months.
20. Significant cerebrovascular event within the last 6 months
21. Existing implanted electrical stimulator (pacemaker, implantable cardioverter defibrillator, deep brain stimulator (DBS), bone growth or pelvic floor stimulators, drug pumps, etc.)
22. Female subject of child-bearing potential and is pregnant or nursing, or intends to become pregnant during the trial period, who is not using a reliable form of birth control
23. Currently enrolled in other potentially confounding research
24. Active infection as determined by the investigator
25. History of any malignancy, other than basal cell carcinoma, in the last 2 years
26. Life expectancy less than 3 years aa. Diagnosed major psychiatric disorder (bipolar, schizophrenia, etc.) bb. Any condition that, at the discretion of the investigator or sponsor, would interfere with accurate interpretation of the study endpoints or preclude participation in the trial
Minimum Eligible Age

22 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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EndoStim Inc.

INDUSTRY

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Nicholas J Shaheen, MD, MPH

Role: PRINCIPAL_INVESTIGATOR

University of North Carolina

Locations

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St. Joseph's Hospital and Medical Center

Phoenix, Arizona, United States

Site Status

HonorHealth Research Institute

Scottsdale, Arizona, United States

Site Status

University of Southern California (USC)

Los Angeles, California, United States

Site Status

Stanford Center for Clinical Research

Stanford, California, United States

Site Status

Institute of Esophageal and Reflux Surgery

Englewood, Colorado, United States

Site Status

University of South Florida

Tampa, Florida, United States

Site Status

Cornell University Weill Medical College

New York, New York, United States

Site Status

Columbia University Medical Center

New York, New York, United States

Site Status

University of North Carolina

Chapel Hill, North Carolina, United States

Site Status

Carolinas HealthCare System

Charlotte, North Carolina, United States

Site Status

The MetroHealth System

Cleveland, Ohio, United States

Site Status

The Ohio State University Medical Center

Columbus, Ohio, United States

Site Status

Oregon Clinic

Portland, Oregon, United States

Site Status

Oregon Health Science University

Portland, Oregon, United States

Site Status

Allegheny Health Network Research Institute

Pittsburgh, Pennsylvania, United States

Site Status

Vanderbilt University Medical Center

Nashville, Tennessee, United States

Site Status

Baylor Scott & White Research Institute

Round Rock, Texas, United States

Site Status

Virginia Commonwealth University

Richmond, Virginia, United States

Site Status

Universitaire Ziekenhuizen Leuven

Leuven, , Belgium

Site Status

Clinical Trial Center Maastricht

Maastricht, , Netherlands

Site Status

University College London

London, , United Kingdom

Site Status

Countries

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United States Belgium Netherlands United Kingdom

Related Links

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Other Identifiers

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CS-100

Identifier Type: -

Identifier Source: org_study_id

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