Improvement of Symptoms After Removal of the Essure® Contraceptive Implant

NCT ID: NCT06355713

Last Updated: 2025-03-07

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

444 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-02-17

Study Completion Date

2037-02-17

Brief Summary

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ESSURE® is an implantable medical device for definitive and irreversible sterilization indicated for adult women of childbearing age. These implants are inserted into the fallopian tubes by hysteroscopy. Marketed in 2002, ESSURE® contraceptive implants were withdrawn from the French market in 2017 (and worldwide in 2017 and 2018) following the observation in certain patients of polymorphic and non-specific gynecological and extra-gynecological symptoms. Studies with small numbers and short-term follow-up have shown a significant improvement in these symptoms after implant explantation. This constitutes a real public health problem since according to the report of the EPI-PHARE Scientific Interest Group, 198,000 French women have these implants and only 30,000 of them, or 15%, have been explanted, knowing that explantation of ESSURE® implants is recommended only in symptomatic patients. A large number of these patients, presenting symptoms, have not yet been treated for an explant.

The physiopathological mechanism(s) is (are) not yet determined but several arguments are in favor of a dissemination of metallic elements contained in these implants whose accumulation could lead to inflammatory and/or allergic and/or autoimmune phenomena.

Carrying out a prospective study with long-term longitudinal follow-up appears essential to precisely assess the degree of improvement in the symptoms and quality of life of these patients, determine the most appropriate surgical techniques, and understand the pathophysiological mechanisms that may result in the implementation of specific treatments and relevant markers. From a surgical point of view, there is a real risk of fracture of implants whatever the type of intervention performed: study the biomechanical properties of implants with a view to characterizing their behavior to mechanical rupture but also their thermal resistance in an objective manner seems essential to limit the risk of fracture and help to inform the patient about the surgical technique proposed for explantation. From a biological point of view, the dosage of the metallic elements constituting ESSURE® implants and potentially toxic ones could make it possible to objectify the release of these metallic elements in the body. Analysis of pro-inflammatory cytokines, micro-RNAs (miRNA), quantitative analysis of inflammatory pathway messenger ribonucleic acid (mRNAs) (NanoString technology) and analysis of neuroinflammation by functional imaging should make it possible to explore potential pathophysiological mechanisms. This study responds to a significant request from patient associations.

Detailed Description

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Conditions

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Implant Complication Contraceptive Device; Complications

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

OTHER

Blinding Strategy

NONE

Study Groups

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Essure Group

Patients requiring removal of the Essure® contraceptive implant

Group Type EXPERIMENTAL

Magnetic resonance imaging- Positron Emission Tomography (MRI-PET) examination

Intervention Type DEVICE

An MRI-PET examination will be carried out pre-operatively and at 6 months for the first 20 patients with Essure® and pre-operatively for the first 10 control patients presenting the selection criteria.

The duration of each acquisition will be approximately 2 hours. Upon arrival, participants will be greeted by electroradiography technicians. A venous catheter will be placed in a vein in the right or left arm. Participants will be installed in the hybrid MRI-PET imager. The injection of \[11C\]PK11195 will take place in the MRI-PET acquisition room. Recording of functional neuroimaging data will begin immediately after intravenous injection of \[11C\]PK11195 and will last for 70 minutes in a resting state.

At the end of the examination, the venous catheter will be removed and the visit will be over.

blood sample

Intervention Type BIOLOGICAL

Patients with Essure : Blood sample pre-operatively (20 mL) and at 2 months (10 mL) and 12 months (5 mL).

Control patients : Blood sample pre-operatively (20 mL)

urine collection

Intervention Type BIOLOGICAL

Patients with Essure : urine collection pre-operatively (10 mL) and at 2 months (10 mL) and 12 months (10 mL).

Control patients : urine collection pre-operatively (10 mL)

Collection of a lock of hair

Intervention Type BIOLOGICAL

Patients with Essure : Collection of a lock of hair pre-operatively and at 12 months Control patients : Collection of a lock of hair pre-operatively

questionnaire

Intervention Type OTHER

Questionnaires pre-operatively (except PGI-I) and at 2, 6, 12 months then twice a year up to 5 years for patients with Essure, and pre-operatively (except PGI-I) and at 2 months for control patients :

* PGI-I: symptom improvement score
* SF-12: quality of life with physical and mental dimension.
* FIQ: quality of life of women with fibromyalgia symptoms
* HADS: anxiety and depressive dimension
* MFI-20: fatigue according to 5 dimensions )
* VAS : pain assessment
* QDSA: assessment of sensory and emotional impact of pain
* FSFI : quality of sexual life
* Higham score

Control Group

Control patients who should benefit from a salpingectomy with or without hysterectomy for a benign indication

Group Type ACTIVE_COMPARATOR

Magnetic resonance imaging- Positron Emission Tomography (MRI-PET) examination

Intervention Type DEVICE

An MRI-PET examination will be carried out pre-operatively and at 6 months for the first 20 patients with Essure® and pre-operatively for the first 10 control patients presenting the selection criteria.

The duration of each acquisition will be approximately 2 hours. Upon arrival, participants will be greeted by electroradiography technicians. A venous catheter will be placed in a vein in the right or left arm. Participants will be installed in the hybrid MRI-PET imager. The injection of \[11C\]PK11195 will take place in the MRI-PET acquisition room. Recording of functional neuroimaging data will begin immediately after intravenous injection of \[11C\]PK11195 and will last for 70 minutes in a resting state.

At the end of the examination, the venous catheter will be removed and the visit will be over.

blood sample

Intervention Type BIOLOGICAL

Patients with Essure : Blood sample pre-operatively (20 mL) and at 2 months (10 mL) and 12 months (5 mL).

Control patients : Blood sample pre-operatively (20 mL)

urine collection

Intervention Type BIOLOGICAL

Patients with Essure : urine collection pre-operatively (10 mL) and at 2 months (10 mL) and 12 months (10 mL).

Control patients : urine collection pre-operatively (10 mL)

Collection of a lock of hair

Intervention Type BIOLOGICAL

Patients with Essure : Collection of a lock of hair pre-operatively and at 12 months Control patients : Collection of a lock of hair pre-operatively

questionnaire

Intervention Type OTHER

Questionnaires pre-operatively (except PGI-I) and at 2, 6, 12 months then twice a year up to 5 years for patients with Essure, and pre-operatively (except PGI-I) and at 2 months for control patients :

* PGI-I: symptom improvement score
* SF-12: quality of life with physical and mental dimension.
* FIQ: quality of life of women with fibromyalgia symptoms
* HADS: anxiety and depressive dimension
* MFI-20: fatigue according to 5 dimensions )
* VAS : pain assessment
* QDSA: assessment of sensory and emotional impact of pain
* FSFI : quality of sexual life
* Higham score

Interventions

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Magnetic resonance imaging- Positron Emission Tomography (MRI-PET) examination

An MRI-PET examination will be carried out pre-operatively and at 6 months for the first 20 patients with Essure® and pre-operatively for the first 10 control patients presenting the selection criteria.

The duration of each acquisition will be approximately 2 hours. Upon arrival, participants will be greeted by electroradiography technicians. A venous catheter will be placed in a vein in the right or left arm. Participants will be installed in the hybrid MRI-PET imager. The injection of \[11C\]PK11195 will take place in the MRI-PET acquisition room. Recording of functional neuroimaging data will begin immediately after intravenous injection of \[11C\]PK11195 and will last for 70 minutes in a resting state.

At the end of the examination, the venous catheter will be removed and the visit will be over.

Intervention Type DEVICE

blood sample

Patients with Essure : Blood sample pre-operatively (20 mL) and at 2 months (10 mL) and 12 months (5 mL).

Control patients : Blood sample pre-operatively (20 mL)

Intervention Type BIOLOGICAL

urine collection

Patients with Essure : urine collection pre-operatively (10 mL) and at 2 months (10 mL) and 12 months (10 mL).

Control patients : urine collection pre-operatively (10 mL)

Intervention Type BIOLOGICAL

Collection of a lock of hair

Patients with Essure : Collection of a lock of hair pre-operatively and at 12 months Control patients : Collection of a lock of hair pre-operatively

Intervention Type BIOLOGICAL

questionnaire

Questionnaires pre-operatively (except PGI-I) and at 2, 6, 12 months then twice a year up to 5 years for patients with Essure, and pre-operatively (except PGI-I) and at 2 months for control patients :

* PGI-I: symptom improvement score
* SF-12: quality of life with physical and mental dimension.
* FIQ: quality of life of women with fibromyalgia symptoms
* HADS: anxiety and depressive dimension
* MFI-20: fatigue according to 5 dimensions )
* VAS : pain assessment
* QDSA: assessment of sensory and emotional impact of pain
* FSFI : quality of sexual life
* Higham score

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

ESSURE Group:

* woman aged 35 to 75
* patient with at least one Essure® implant
* surgical intervention planned because the patient is symptomatic: removal of the Essure® implant(s)
* planned intervention via vaginal route, laparoscopy, robotic surgery, or Transvaginal natural orifice transluminal endoscopic surgery (VNotes)
* patient having given free, informed and signed consent

Selection for MRI-PET examination:

* if the answer is "poor" or "bad" to the first question of the SF-12 pre-operatively
* no hysterectomy
* no analgesic treatment, or treatment stopped 48 hours before the examination
* no psychotropic treatment (anxiolytics, hypnotics (sleeping pills), antidepressants, mood stabilizers, neuroleptics)
* patient having given free, informed and signed consent

Control group:

* woman aged 35 to 75
* planned surgical intervention: salpingectomy with or without hysterectomy for benign indication
* planned intervention via vaginal route, laparoscopy, robotic surgery, or VNotes
* patient having given free, informed and signed consent

Selection for MRI-PET examination:

* age matching (+/- 5 years) with Essure® patients who have had an MRI-PET
* matching on surgical technique with Essure® patients who have had an MRI-PET: salpingectomy with or without hysterectomy
* no analgesic treatment, or treatment stopped 48 hours before the examination
* no psychotropic treatment (anxiolytics, hypnotics (sleeping pills), antidepressants, mood stabilizers, neuroleptics)
* patient having given free, informed and signed consent

Exclusion Criteria

ESSURE Group:

* asymptomatic patient
* planned intervention by laparotomy
* patient potentially exposed to other heavy metals: wearer of metallic orthopedic equipment (hip or knee prosthesis, etc.), wearer of coronary stent, or tubal ligation clip
* inability to understand the information given
* persons deprived of liberty by a judicial or administrative decision
* people undergoing psychiatric care
* people admitted to a health or social establishment for purposes other than research
* adults subject to a legal protection measure (guardianship, curatorship)
* people not affiliated to a social security scheme or beneficiaries of a similar scheme
* person participating in another interventional research that may interfere with the research

Selection for MRI-PET examination:

* claustrophobia
* dosimetry of all radiological examinations over the past year not acceptable

Control Group :

* current pregnancy
* patient with cancer
* patient who has already had an Essure® implant removed
* patient potentially exposed to heavy metals: wearer of metallic orthopedic equipment (hip or knee prosthesis, etc.), wearer of coronary stent, or tubal ligation clip
* planned intervention by laparotomy
* inability to understand the information given
* persons deprived of liberty by a judicial or administrative decision
* people undergoing psychiatric care
* people admitted to a health or social establishment for purposes other than research
* adults subject to a legal protection measure (guardianship, curatorship)
* people not affiliated to a social security scheme or beneficiaries of a similar scheme
* person participating in another interventional research that may interfere with the research

Selection for MRI-PET examination:

* claustrophobia
* dosimetry of all radiological examinations over the past year not acceptable
Minimum Eligible Age

35 Years

Maximum Eligible Age

75 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Hospices Civils de Lyon

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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CHU de Angers

Angers, , France

Site Status NOT_YET_RECRUITING

Hôpital Femme Mère Enfant (Hospices Civils de Lyon)

Bron, , France

Site Status RECRUITING

Hôpital Bicêtre

Le Kremlin-Bicêtre, , France

Site Status NOT_YET_RECRUITING

Hôpital Jeanne de Flandres

Lille, , France

Site Status NOT_YET_RECRUITING

Hôpital de La Conception

Marseille, , France

Site Status NOT_YET_RECRUITING

Institut Mère Enfant Alix de Champagne, CHU Reims

Reims, , France

Site Status NOT_YET_RECRUITING

CHU de Rouen

Rouen, , France

Site Status NOT_YET_RECRUITING

Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg

Strasbourg, , France

Site Status NOT_YET_RECRUITING

Hôpital Paule de Viguier, CHU de Toulouse

Toulouse, , France

Site Status NOT_YET_RECRUITING

Hôpital André Mignot, Centre Hospitalier de Versailles

Versailles, , France

Site Status NOT_YET_RECRUITING

Countries

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France

Central Contacts

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Gautier Chene, PU,PH

Role: CONTACT

0472355870 ext. +33

Stéphanie MORET

Role: CONTACT

0472355878 ext. +33

Facility Contacts

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Guillaume Legendre, PU,PH

Role: primary

0241354635 ext. +33

Gautier Chene, PU,PH

Role: primary

0472355870 ext. +33

Perrine CAPMAS, PU,PH

Role: primary

0145217714 ext. +33

Victoire Delporte, PU,PH

Role: primary

0320446641 ext. +33

Aubert Agostini, PU,PH

Role: primary

0491383702 ext. +33

Olivier Graesslin, PU,PH

Role: primary

0326783517 ext. +33

Patrice Crochet, PU,PH

Role: primary

0232881054 ext. +33

Thomas Boisrame, PU,PH

Role: primary

0388127458 ext. +33

Yann Tanguy Le Gac, PU,PH

Role: primary

0567771105 ext. +33

Pierre Panel, PU,PH

Role: primary

0139638936 ext. +33

Other Identifiers

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2023-A02010-45

Identifier Type: OTHER

Identifier Source: secondary_id

69HCL23_0899

Identifier Type: -

Identifier Source: org_study_id

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