A Study Comparing the Effectiveness of EndoRotor Versus Radiofrequency in Treating Barrett's Esophagus

NCT ID: NCT04867590

Last Updated: 2024-04-09

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

RECRUITING

Clinical Phase

NA

Total Enrollment

140 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-03-25

Study Completion Date

2027-05-31

Brief Summary

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Barrett Esophagus is a common pathology, with an estimated prevalence of 1.6% at risk of progression to precancerous mucosa (low to high grade dysplasia). The incidence of adenocarcinoma on BE is 0.5% per year. In the event of dysplasia or cancer in situ, it is currently recommended at international and particularly European level to eradicate BE. The treatment techniques used to date carry out thermal destruction of the BE, in particular by radiofrequency. Eradication of dysplasia is achieved in 81% to 100% and disappearance of BE in 73% to 87% of cases. It requires an average of 3 destruction sessions. RF does not allow histological analysis after destruction of BE, but the risk of progression to neoplasia is estimated at 7.8/1000 persons per year. This risk could be due to the presence of glands buried in the esophageal mucosa. Indeed, these glands are not destroyed by thermal ablation methods, and remain invisible during endoscopic controls.

A new treatment technique using the Endorotor® system allows mechanical resection of the entire mucosa in one session of treatment. In addition, the cost of these thermal destruction techniques currently limits their wider diffusion. It is therefore legitimate to propose a less expensive and probably more effective alternative technique.

Detailed Description

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Conditions

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Barrett Esophagus Dysplasia

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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EndoRotor

The ENDOROTOR is a new system for the resection of superficial lesions within the digestive tract and composed of a reusable generator, a single-use probe and additional accessories.

The device is used in the resection of mucosa in the digestive tract: flat or slightly raised lesions in the digestive mucosa, or treatment of the lateral margins following a resection carried out using another technique.

Resected tissue is aspirated away through a rotating catheter: the cutting and removal of tissue as well as the collection of specimens are combined into one act.

Group Type EXPERIMENTAL

Endorotor

Intervention Type DEVICE

The treatment itself is preceded by a sub-mucosa saline and adrenalin solution injection administered by an endoscopic sclerotherapy needle lifting the submucosa and thus reducing the risk of perforation and hemorrhage.

The interventional tool is then applied tangentially to be brought into contact with the lifted mucosa, visual monitored by endoscope. The aspiration and sectioning system is activated by use of a pedal and a generator specially made for the system, used in every procedure. The entire surface area of the targeted mucosa must be covered by the probe. The residual tissue is then removed via the aspiration system and caught by a filter. The specimens are then easily retrievable at the end of the procedure and can be stored in formalin fixing solution for histological analysis.

Radiofrequency

Endoscopic treatment using the HALO® 360 or 90 system is a thermal ablation system for superficial mucosa. First and foremost, the examination includes an endoscopy to locate the upper limits of the BE and its distribution, so as to choose the most appropriate type of probe. An initial debridement of the mucosal deposits is carried out by application of acetylcysteine in spray form with a spray catheter on the entire mucosal surface to be treated and then rinsed with water after a minute of application time.

Group Type ACTIVE_COMPARATOR

Radiofrequency

Intervention Type DEVICE

Endoscopic treatment using the HALO® 360 or 90 system is a thermal method for destroying the superficial mucosa. An initial debridement of the mucosal deposits is carried out by application of acetylcysteine in spray form with a spray catheter on the entire mucosal surface to be treated and then rinsed with water after a minute of application time.

For circumferential BEs, a single-use 360 Express® probe is used to make it possible to size the diameter of the esophagus and the treatment used. The length of the treatment area is 5 cm and several points of impact can be achieved by overlapping the catheter at two consecutive heights, with the zone spanned measuring one centimeter, in order to cover the entire pathological area requiring treatment.

For non-circumferential lesions a "palette" applicator is used in a variety of sizes, and in this context no sizing of the esophagus is required.

Interventions

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Endorotor

The treatment itself is preceded by a sub-mucosa saline and adrenalin solution injection administered by an endoscopic sclerotherapy needle lifting the submucosa and thus reducing the risk of perforation and hemorrhage.

The interventional tool is then applied tangentially to be brought into contact with the lifted mucosa, visual monitored by endoscope. The aspiration and sectioning system is activated by use of a pedal and a generator specially made for the system, used in every procedure. The entire surface area of the targeted mucosa must be covered by the probe. The residual tissue is then removed via the aspiration system and caught by a filter. The specimens are then easily retrievable at the end of the procedure and can be stored in formalin fixing solution for histological analysis.

Intervention Type DEVICE

Radiofrequency

Endoscopic treatment using the HALO® 360 or 90 system is a thermal method for destroying the superficial mucosa. An initial debridement of the mucosal deposits is carried out by application of acetylcysteine in spray form with a spray catheter on the entire mucosal surface to be treated and then rinsed with water after a minute of application time.

For circumferential BEs, a single-use 360 Express® probe is used to make it possible to size the diameter of the esophagus and the treatment used. The length of the treatment area is 5 cm and several points of impact can be achieved by overlapping the catheter at two consecutive heights, with the zone spanned measuring one centimeter, in order to cover the entire pathological area requiring treatment.

For non-circumferential lesions a "palette" applicator is used in a variety of sizes, and in this context no sizing of the esophagus is required.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Adult patients presenting Barrett's esophagus of a size between 2 cm and 6 cm in the height of the longest tonguea with low to high grade dysplasia that is histologically proven or with a superficial non-invasive adenocarcinoma that has been resected a The total height of the BE is evaluated according to the Prague classification, with the height of the circumferential segment between 0 cm (non-circumferential segment) and 6 cm (segment shaped like a full sleeve for 6 cm), referred to as C0 to C6, and the height of the longest tongue between 2 cm and 6 cm (M2- M6).
* Patients must have signed the consent form in order to participate in the study
* Patients are pre-included (signature of consent) before the histological confirmation of dysplasiab and/or superficial non-invasive adenocarcinoma that allows the patient to be included in the study.

Exclusion Criteria

* Individuals over 85 years old
* Women who are pregnant, breastfeeding or in labour
* Individuals in detention through judicial or administrative decision
* Individuals who are the subject of psychiatric treatment under duress
* Individuals who are subjects of legal protection measures
* Individuals who are in no state to give their consent
* Individuals who do not understand French or do not know how to read
* Individuals who are not part of a social security program or benefit from such a scheme
* Those with active peptic and/or radiation-induced or complicated esophagitis at the time of treatment
* Presence of a visible lesion that is suspected to be esophageal cancer confirmed by biopsies
* Anterior resection of invasive adenocarcinoma using endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) with invasion of the lateral and/or deep margin, adenocarcinoma of poorly differentiated characteristics or sub-mucosal invasion \> 500µm (pT1b)
* All preliminary ablation treatments or dilation for esophageal stenosis
* Significant esophageal stenosis: cannot be passed with a standard gastroscope
* Presence of esophageal varices or portal hypertension
* Anticoagulant treatment that cannot be stopped before the intervention (excluding 100 mg maximum per day of aspirin in single-drug treatment) or any haemostasis problems that cannot be corrected
* Having a contraindication regarding anaesthesia
* Patients incapable of taking proton pump inhibitors (PPIs) orally.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University Hospital, Angers

OTHER_GOV

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Elodie CESBRON-METIVIER, Ph.D.

Role: PRINCIPAL_INVESTIGATOR

UH Angers

Locations

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University Hospital of Brest

Brest, , France

Site Status NOT_YET_RECRUITING

University Hospital of Tours

Chambray-lès-Tours, , France

Site Status NOT_YET_RECRUITING

University Hospital of Lille

Lille, , France

Site Status NOT_YET_RECRUITING

University Hospital of Limoges

Limoges, , France

Site Status NOT_YET_RECRUITING

Edouard Herriot Hospital

Lyon, , France

Site Status RECRUITING

University Hospital of Nantes

Nantes, , France

Site Status NOT_YET_RECRUITING

University Hospital of Nice

Nice, , France

Site Status NOT_YET_RECRUITING

Cochin Hospital

Paris, , France

Site Status RECRUITING

Georges Pompidou European Hospital

Paris, , France

Site Status RECRUITING

University Hospital of Bordeaux

Pessac, , France

Site Status RECRUITING

University Hospital of Poitiers

Poitiers, , France

Site Status NOT_YET_RECRUITING

University Hospital of Rennes

Rennes, , France

Site Status NOT_YET_RECRUITING

Countries

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France

Central Contacts

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Elodie CESBRON-METIVIER, Ph.D.

Role: CONTACT

+33241353148

DRCI CHU Angers

Role: CONTACT

+33241356329

Facility Contacts

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Franck CHOLET, Ph.D.

Role: primary

Driffa MOUSSATA, Ph.D.

Role: primary

Julien BRANCHE, Ph.D.

Role: primary

Jérémie JACQUES, Ph.D.

Role: primary

Mathieu PIOCHE, Ph.D.

Role: primary

Emmanuel CORON, Ph.D.

Role: primary

Geoffroy VANBIERVLIET, Ph.D.

Role: primary

Maximilien BARRET, PH.D.

Role: primary

Gabriel RAHMI, Ph.D.

Role: primary

Arthur BERGER, Ph.D.

Role: primary

Thierry BARRIOZ, Ph.D.

Role: primary

Timothée WALLENHORST, Ph.D.

Role: primary

Other Identifiers

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2020-A00975-34

Identifier Type: -

Identifier Source: org_study_id

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