GastrOesophageal Varices After Sustained Virological Response

NCT ID: NCT04191018

Last Updated: 2019-12-09

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

Total Enrollment

322 participants

Study Classification

OBSERVATIONAL

Study Start Date

2019-11-26

Study Completion Date

2024-02-28

Brief Summary

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Chronic hepatitis C remains a public health issue because up to 70 million people are chronically infected by hepatitis C virus (HCV) worldwide. Presence of advanced fibrosis/cirrhosis might be associated with liver-related complications, such as hepatocellular carcinoma and oesophageal varices bleeding. Oesophageal varices (OV) might be present in up to 40% of patients with liver cirrhosis have and the mortality rates from bleeding might be up to 20% per episode. Early diagnosis of advanced fibrosis/cirrhosis associated with hepatitis C treatment are key features for preventive and therapeutic measures to reduce liver-related mortality in HCV-infected patients.

Liver elastography is a high accurate non-invasive test for diagnosis of advanced fibrosis/cirrhosis. Few different methods of liver elastography are currently available: transient elastography by Fibroscan and ultrasound elastography by point-shear wave (p-SWE) and 2D-shear wave (2D-SWE). Gastrointestinal endoscopy (GIE) has been considered the gold standard for screening or surveillance of esophageal varices. More recently, international guidelines have been recommending the use of non-invasive methods to indicate or avoid OV screening: Baveno VI guidelines proposed that compensated cirrhotic patients with a liver stiffness measurement (LSM) by transient elastography \<20kPa and a platelet count \>150,000/μL can avoid screening endoscopy. The use of direct-acting agents (DAAs) has revolutionized the treatment of chronic hepatitis C with high effectiveness shown using all-oral interferon-free regimens. HCV cure, sustained virological response (SVR), has been associated with lower rates of liver-related complications, increase in quality of life and decrease in waiting-list registrations for liver transplantation in patients with chronic hepatitis C. Preliminary studies have been reporting significant regression liver stiffness after SVR. However, it is unclear whether SVR might decrease portal hypertension leading to OV regression and a reduced risk of variceal bleeding. In addition, the use of non-invasive methods to avoid OV screening must be validated in HCV patients after SVR. The aims of this cross-sectional study with prospective inclusion of patients will be: (i) to evaluate the impact of SVR in portal hypertension in HCV patients with advanced fibrosis/liver cirrhosis treated by interferon-free regimens and (ii) to validate non-invasive methods to avoid OV screening by GIE

Detailed Description

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Conditions

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Liver Diseases Hepatitis C

Keywords

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sustained virological response portal hypertension cirrhosis gastrointestinal endoscopy

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Interventions

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Liver elastography

Liver stiffness measurement

Intervention Type DIAGNOSTIC_TEST

Splenic elastography

Splenic stiffness measurement

Intervention Type DIAGNOSTIC_TEST

Gastrointestinal endoscopy

Gastrointestinal endoscopy

Intervention Type DIAGNOSTIC_TEST

Other Intervention Names

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transient elastography (Fibroscan) 2D-shear wave (GE Healthcare) point-shear wave (Phillips) transient elastography (Fibroscan) 2D-shear wave (GE Healthcare) point-shear wave (Phllips) esophagogastroduodenoscopy

Eligibility Criteria

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Inclusion Criteria

* Age ≥ 18 years
* Presence of advanced fibrosis or cirrhosis (stage F≥3 METAVIR) based on liver stiffness by transient elastography (≥ 9,5 kPa) or liver biopsy
* Gastrointestinal endoscopy at least 24 months before start of direct-acting agents for HCV treatment
* Liver stiffness measurement at least 18 months after SVR

Exclusion Criteria

* Autoimmune hepatitis, hepatosplenic schistosomiasis or cholestasis diseases
* Liver transplantation
* Presence of high volume ascites or hepatocellular carcinoma
* Participation in programs of esophageal band ligation for eradication of esophageal varices
* Presence of signs of acute decompensated liver disease
Minimum Eligible Age

18 Years

Maximum Eligible Age

99 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Oswaldo Cruz Foundation

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Hugo Perazzo, PhD

Role: PRINCIPAL_INVESTIGATOR

Oswaldo Cruz Foundation

Locations

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Evandro Chagas National Institute of Infectious Diseases

Rio de Janeiro, Rio de Janeiro/RJ, Brazil

Site Status RECRUITING

Bonsucesso Federal Hospital

Rio de Janeiro, , Brazil

Site Status RECRUITING

Countries

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Brazil

Central Contacts

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Hugo Perazzo, PhD

Role: CONTACT

Phone: +5521 3865-9587

Email: [email protected]

Facility Contacts

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Hugo Perazzo, PhD

Role: primary

Gustavo Pereira, PhD

Role: primary

Flavia Fernandes, PhD

Role: backup

Other Identifiers

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10320319.6.0000.5262

Identifier Type: -

Identifier Source: org_study_id