StomaphyX Versus Sham for Revisional Surgery in Post-Roux-en-Y Patients to Reduce Regained Weight

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00939055
Recruitment Status : Terminated (Based on futility analysis, study would not meet primary endpoint.)
First Posted : July 14, 2009
Results First Posted : June 5, 2014
Last Update Posted : June 5, 2014
Information provided by (Responsible Party):
EndoGastric Solutions

Brief Summary:
The Roux-en-Y gastric bypass (RNYGB) is a weight loss surgery that involves the creation of a small gastric pouch and rearrangement of the small intestine. Although RNYGB has been demonstrated as an effective bariatric procedure, a significant number of patients experience weight regain that is often associated with distended gastric anatomy. Open and laparoscopic approaches for revision are associated with higher complication rates than de novo procedures. This study will evaluate the safety and effectiveness of a revisional incisionless natural orifice surgery of the gastric pouch and stoma in producing weight loss in post-RNYGB patients who have experienced weight regain.

Condition or disease Intervention/treatment Phase
Obesity Device: StomaphyX Procedure: Sham procedure Phase 2 Phase 3

Detailed Description:

The Roux-en-Y gastric bypass (RNYGB) is the most commonly performed bariatric procedure to treat morbid obesity 1. Numerous studies have documented the effectiveness of RNYGB in promoting excess weight loss (EWL) typically in the 65-80% range after 1.5 to 2 years 1. Despite the favorable short-term outcomes of this bariatric surgical procedure, approximately 10-40% of patients do not achieve successful long-term weight loss 2. The weight regain occurs typically within 2 to 7 years after RNYGB surgery and is associated primarily with dilation of the gastric pouch or stoma 3, 4. Several open and laparoscopic bariatric revision procedures have been used in an attempt to correct these dilations, but they all have been associated with serious complications such as perforations, obstruction, staple line disruption, blind loop syndrome, stoma ulcer, and incisional hernias 2, 5, 6. Because of this high rate of morbidity associated with revisional gastric bypass surgery, less invasive endoscopic procedures may become a preferred approach for weight regain after RNYGB 7, 8.

The StomaphyX delivery system with SerosaFuse fasteners consist of an ergonomic, flexible fastener delivery device and sterile polypropylene fastener implants. The unit is provided sterile and is a single use device. The polypropylene fasteners are proprietary and function only with the StomaphyX device. The device uses vacuum to invaginate tissue through a port into a chamber and fasten it using the H shaped polypropylene fasteners. The fastener delivery subsystem is comprised of 3 elements: stylet, pusher, and internal lumens. They run the length of the device, the pusher being a hollow tube that rides over the length of the stylet, both riding in the lumen. The stylet is sharp at the distal tip to pierce tissue. The fastener is loaded by snapping it onto the stylet in the loading port of the handle. When pushed by the operator, the stylet carries the fastener down the lumen which runs from the proximal handle assembly to the distal tissue port where it will eventually be deployed into the tissue. Durability of the SerosaFuse fasteners has been demonstrated during several clinical studies utilizing the EsophyX device 9-12.

Reason for Conducting the Present Study: The goal of this study was to investigate the safety and effectiveness of the StomaphyX device for revisional natural orifice surgery of the gastric pouch and gastrojejunostomy anastomosis (stoma) in RNYGB patients to reduce regained weight.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 112 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Participant)
Primary Purpose: Treatment
Official Title: A Randomized Controlled Trial of StomaphyX Versus Sham for Revisional Surgery in Post-Roux-en-Y Patients to Reduce Regained Weight
Study Start Date : July 2009
Actual Primary Completion Date : June 2012
Actual Study Completion Date : June 2012

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Body Weight

Arm Intervention/treatment
Experimental: StomaphyX
Post-Roux-en-Y revisional surgery using the StomaphyX device.
Device: StomaphyX
Transoral incisionless fastening device that allows for GI tissue approximation and creation of full-thickness (serosa-to-serosa) plications.
Other Name: transoral incisionless fastening device

Sham Comparator: Sham Procedure
No intervention
Procedure: Sham procedure
False procedure
Other Name: Placebo

Primary Outcome Measures :
  1. Weight Loss [ Time Frame: 12 month ]
    A clinically significant reduction in pre-RNYGB excess weight, defined by ≥15% EBL and BMI < 35.

Secondary Outcome Measures :
  1. Quality of Life [ Time Frame: 12 months ]
    Quality of life as assessed by the Impact of Weight on Quality of Life Questionnaire (IWQOL-Lite); a ≥ 10 total score improvement from baseline (screening) will represent a clinically significant improvement.

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 64 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • At least 18 years of age and less than 65 years of age
  • BMI of at least 35 and no more than 40
  • At least 2 years post-RNYGB surgery
  • Initially achieved at least 60% EBL and a BMI 35 or less
  • Regained at least 20% of pre-RNYGB excess weight at screening
  • Stable weight or continued failure to lose weight for at least 3 months
  • Enlarged gastric pouch (≥ 30 ml)
  • Anatomy of upper GI judged suitable for revision using StomaphyX
  • Completed successful nutritional screening
  • Normal levels of vitamin D, iron/ferritin, calcium, and magnesium
  • Absence of protein malnutrition confirmed by serum albumin > 3 g/dL
  • Willing to cooperate with follow-up dietary recommendations and assessment tests
  • Signed Informed Consent

Exclusion Criteria:

  • Previous revisional bariatric surgery after RNYGB
  • Esophageal stricture or any anatomic condition that precludes passage of the StomaphyX device to the gastric pouch
  • Diabetes type I
  • Causal factors for weight regain other than gastric pouch enlargement
  • Serious complications experienced during and/or after RNYGB such as leaks, fistula, incisional hernia, ulcers, pulmonary embolism or deep venous thrombosis
  • Pregnancy or plans of pregnancy in the next 12 months
  • Immunosuppression
  • ASA > 3
  • Life expectancy less than one year
  • An eating disorder, as defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th Ed, Washington DC, American Psychiatric Association, 2000
  • Active substance abuse
  • Plans of smoking cessation in the next 12 months
  • Treatment with weight-loss prescription drug therapy within three months preceding the screening
  • Intention to use prescription drug therapy or the use of over-the-counter weight-loss preparations during the current study
  • Current participant in another weight-loss study or other clinical trial
  • Inflammatory bowel disease
  • Presence of ulceration at the gastrojejunostomy anastomosis
  • Portal hypertension
  • Coagulation disorders or chronic use of anticoagulants
  • Any active medical condition that would preclude the patient from completing the study or would result in an unreasonable risk to the patient

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00939055

United States, Ohio
The Ohio State University Medical Center
Columbus, Ohio, United States, 43210
United States, Pennsylvania
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania, United States, 15213
Sponsors and Collaborators
EndoGastric Solutions
Principal Investigator: Anita P. Courcoulas, MD MPH FACS University of Pittsburgh

Publications automatically indexed to this study by Identifier (NCT Number):
Responsible Party: EndoGastric Solutions Identifier: NCT00939055     History of Changes
Other Study ID Numbers: D00764
First Posted: July 14, 2009    Key Record Dates
Results First Posted: June 5, 2014
Last Update Posted: June 5, 2014
Last Verified: May 2014