SEAM Trial: Sutureless End to End Anastomosis by Magnetic Compression

NCT ID: NCT05046730

Last Updated: 2024-10-15

Basic Information

• Recruitment Status: TERMINATED
• Clinical Phase: NA
• Total Enrollment: 128 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2022-02-01
• Study Completion Date: 2023-12-30

Brief Summary

The objectives of this study are to determine the safety and effectiveness of the SFM Anastomosis Device when used to create a small bowel anastomosis for patients undergoing ileostomy reversal as compared with a propensity-matched historic control group of patients who underwent ileostomy reversal using a conventional closure technique (sutures or stapler).

Detailed Description

This is a multicenter, single-arm study in which clinical outcomes prospectively evaluated for a minimum of 100 subjects undergoing ileostomy reversal using the SFM Anastomosis Device will be 1:1 propensity score matched through nearest neighbor matching to a historical control cohort of patients who underwent ileostomy reversal using conventional closure techniques. In order to have a sufficient pool of retrospective patients for matching, retrospective data will be collected for a minimum of 300 patients. The historical control cohort will be accrued from the same pool of institutions participating in the prospective study. Eligibility criteria will be standardized between the prospective investigational treatment arm and the historical control. Within this analysis, propensity score (PS) matching will be used to reduce bias due to potential differences in key covariates between the prospective and retrospective cohorts.

Conditions

Retraction of Ileostomy

Study Design

• Allocation Method: NON_RANDOMIZED
• Intervention Model: FACTORIAL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Prospective Evaluation of the SFM Device

This is a multicenter, single-arm study in which clinical outcomes prospectively evaluated for a minimum of 100 subjects undergoing ileostomy reversal using the SFM Anastomosis Device

Group Type: EXPERIMENTAL

Ileostomy Reversal using Self Forming Magnets (SFM)

Intervention Type: DEVICE

The magnets will be manually deployed into the small intestine during open surgery following creation of a mini or full laparotomy as clinically indicated. Once the desired segment of small bowel is resected, the magnet is inserted through the open ends of each bowel section. Once proper magnet position is confirmed and the bowel ends are approximated, the magnets couple to form the anastomosis.

Retrospective Chart Review of Historical Controls

In order to have a sufficient pool of retrospective patients for matching, retrospective data will be collected for a minimum of 300 patients. The historical control cohort will be accrued from the same pool of institutions participating in the prospective study.

Group Type: ACTIVE_COMPARATOR

Ileostomy Reversal using Self Forming Magnets (SFM)

Intervention Type: DEVICE

The magnets will be manually deployed into the small intestine during open surgery following creation of a mini or full laparotomy as clinically indicated. Once the desired segment of small bowel is resected, the magnet is inserted through the open ends of each bowel section. Once proper magnet position is confirmed and the bowel ends are approximated, the magnets couple to form the anastomosis.

Interventions

Ileostomy Reversal using Self Forming Magnets (SFM)

The magnets will be manually deployed into the small intestine during open surgery following creation of a mini or full laparotomy as clinically indicated. Once the desired segment of small bowel is resected, the magnet is inserted through the open ends of each bowel section. Once proper magnet position is confirmed and the bowel ends are approximated, the magnets couple to form the anastomosis.

Intervention Type: DEVICE

Eligibility Criteria

Inclusion Criteria

1. Participants must be >18 years

2. Participant has a temporary loop ileostomy that was created ≥ 2 months but ≤ 10 months prior to reversal. NOTE: The inclusion of patients with ileostomy after total colectomy and palliative ileostomy is permitted if the patients have estimated overall survival of greater than 2 years or if the loop ileostomy is resulting in persistent fluid and electrolyte disorders or other significant stoma related complications where closure of the ileostomy is required for patient safety.

3. Preoperative clearance with confirmation of anastomotic integrity of the original resection; i.e., absence of active exacerbation of inflammatory disease (as applicable), stricture or leakage at or distal to the diverted colorectal anastomosis via gastrografin enema and/or endoscopy based on physician's discretion

4. BMI ≤ 40 kg/m2

5. American Society of Anesthesiologist (ASA) score < IV at time of reversal

6. All cancer patients must have completed chemotherapy ≥2 months prior to ileostomy closure

7. Subject or authorized representative have been informed of the nature of the study and has provided written informed consent approved by the appropriate local Institutional Review Board (IRB) and agrees to comply with all protocol-specified follow-up appointments

Exclusion Criteria

1. Radiological or clinical signs of anastomosis leak, active infection (except uncomplicated urinary tract infection)

2. Ongoing or prolonged ileus or bowel obstruction from original surgery

3. Requires/d additional abdominal surgery (e.g., Major hernia repair, either necessitating mesh and/or abdominal wall reconstruction) after ileostomy or requires/d concurrent abdominal surgery during reversal procedure

4. Multiple small bowel obstructions occurring between ileostomy creation and closure requiring a formal abdominal exploration through a midline incision at the time of ileostomy closure or any other participant in whom laparotomy is required at time of ileostomy closure

5. Requires/d laparotomy at time of ileostomy closure

6. Congestive heart failure with ejection fraction<35% or clinically significant arrhythmia (any rhythm disturbances except sinus tachycardia, sinus bradycardia or a sinus rhythm with premature atrial or ventricular complexes)

7. Decompensated chronic obstructive lung disease

8. Pulmonary embolism or myocardial infarction in the prior 6 months

9. Congenital or acquired anomalies of the gastrointestinal tract, including atresias, stenosis, luminal distortion or malrotation

10. Coagulation deficiency not normalized by medical treatment or platelet count <50,000/µL at time of reversal

11. Known moderate to severe renal disease (eGFR < 44 milliliters per minute per 1.73m2) or ongoing dialysis

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

GI Windows, Inc.

INDUSTRY

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Evangelos Messaris, MD, Ph.D

Role: PRINCIPAL_INVESTIGATOR

Beth Israel Deaconess Medical Center

Locations

Advent Health

Orlando, Florida, United States

Colon and Rectal Clinical of Orlando

Orlando, Florida, United States

Beth Israel Deaconess Medical Center

Boston, Massachusetts, United States

University of Massachusetts Medical School

Worcester, Massachusetts, United States

Spectrum Health / Ferguson Clinic

Grand Rapids, Michigan, United States

Trinity Health Michigan Heart

Ypsilanti, Michigan, United States

Dartmouth Hitchcock Medical Center

Lebanon, New Hampshire, United States

The Mount Sinai Medical Center

New York, New York, United States

St Francis Hospital

Roslyn, New York, United States

Novant Health Clinical Research

Winston-Salem, North Carolina, United States

Penn State Milton S. Hershey Medical Center

Hershey, Pennsylvania, United States

Vanderbilt University Medical Center

Nashville, Tennessee, United States

UT Health Science Center at Houston

Houston, Texas, United States

The Medical College of Wisconsin

Milwaukee, Wisconsin, United States

Countries

United States

Other Identifiers

GIW 21-002

Identifier Type: -

Identifier Source: org_study_id