Multicenter Prospective Randomized Controlled Trial of Plicated Laparoscopic Adjustable Gastric Banding

• ClinicalTrials.gov Identifier: NCT01564732
• Recruitment Status: Terminated
• First Posted: March 28, 2012
• Results First Posted: June 1, 2016
• Last Update Posted: July 1, 2016
• Sponsor: Dana Portenier, MD
• Collaborator: Allergan
• Information provided by (Responsible Party): Dana Portenier, MD, Duke University

Study Description

Brief Summary:

The purpose of this study is to compare plicated laparoscopic adjustable gastric banding (PLAGB) to standard laparoscopic adjustable gastric banding (SLAGB) in a prospective randomized clinical trial. We hypothesize the plicated procedure will provide greater short- and long-term excess weight loss than the standard procedure. There exists little prospective randomized data regarding this topic and the recent position statement from the American Society for Metabolic and Bariatric Surgery (ASMBS) encourages this type of study. Further information on background and design of this study are provided in the detailed description.

Condition or disease	Intervention/treatment	Phase
Morbid Obesity	Device: Standard-LAGB; Device: Plicated-LAGB	Not Applicable

Detailed Description:

Morbid obesity is a major problem affecting the lives of millions in the US. As of 2008, overall prevalence of obesity as defined by body mass index (BMI) greater than 30 kg/m2 was 33.8%.1 Obesity adversely affects the lives of millions of Americans by increasing the risk for co-morbid conditions such as diabetes mellitus, obstructive sleep apnea, hypertension, and even certain cancers.2-4 The laparoscopic adjustable gastric banding (LAGB) procedure is a safe, effective, and durable treatment option for refractory morbid obesity and its related health consequences.5 This minimally invasive technique is now a popular approach for bariatric surgery, and it offers obvious advantages such as decreased operating time, shorter hospital stay (often same day surgery), and favorable complication rates as compared with other bariatric procedures.4,5

One of the biggest drawbacks to LAGB [when compared to the 'gold standard' of bariatric surgery: Roux-en-Y gastric bypass] is that patients tend to have a slower, less dramatic weight loss in the first few months after surgery.5-7 In addition, the LAGB procedure is associated with an approximate 3% chance of "band slippage" complications.8 In order to address some of these issues modifications in the technique of LAGB surgery have been made. Techniques such as a "pars-flaccida approach" to tissue dissection and the placement of plication sutures to "anchor" the redundant stomach around the newly placed band device were introduced and shown to have positive results in reducing band complication rates.8 More recently, sleeve gastrostomy procedures (the greater curvature and significant portion of the body of the stomach is resected over a sizing bougie; leaving a narrow 'sleeve' of stomach) have also become popular in treating patients with morbid obesity.9 Combining these concepts, a modified technique of plicated LAGB was introduced.

At the time of LAGB placement, plication sutures can be placed along the body & greater curvature of the stomach to "tighten" and "cinch up" the stomach in a sleeve-like orientation. It was recently reported that this modified technique of plicated LAGB could result in lower band slippage complication rates and faster, early weight loss.8

However, as of today there exists no prospective, randomized study that compares the outcomes of this modified surgical technique to the standard procedure (SLAGB).

This is a prospective randomized clinical trial comparing PLAGB versus SLAGB. All adult (age older than 18 years) morbidly obese patients meeting NIH criteria for bariatric surgery (BMI > 35 + co-morbid disease or BMI > 40) who are undergoing bariatric surgery at the Duke Metabolic and Weight Loss Surgery Center and the University of Pittsburgh Medical Center will be recruited. All enrolled patients will be randomly assigned to either the SLAGB (control) group or the PLAGB (study) group. Variables to be studied include patient age, gender, ethnicity, co-morbid disease conditions, height, weight, BMI, intra-operative data such as operative time and blood loss, and post-operative outcomes including length of hospital stay, complication rates, weight loss, and co-morbid disease resolution. In addition, each patient will complete standardized surveys rating their satisfaction from surgery, their quality of life (OWL-QOL-17), and their sleepiness (Epworth Sleepiness Scale) at three distinct time intervals: pre-operatively and at weeks 24 & 48.

Each subject will be followed and data collected according to the following schedule of visits:

Study Visit Schedule:

Year 1:

Visit 1: Screening Visit Visit 2: Day 0 (surgery) Visit 3: Week 2 (+/- 2 days) Visit 4: Week 4 (1 month) Visit 5: Week 8 (2 months) Visit 6: Week 12 (3 months) Visit 7: Week 16 (4 months) Visit 8: Week 20 (5 months) Visit 9: Week 24 (6 months) Visit 10: Week 30 Visit 11: Week 36 Visit 12: Week 42 Visit 13: Week 48

Year 2:

Visit 14: Week 60 Visit 15: Week 72 Visit 16: Week 84 Visit 17: Week 96

Year 3:

Visit 18: Week 128 (2.5 yrs) Visit 19: Week 156 (3 yrs)

Data gathered from PLAGB subjects will be compared to SLAGB controls. Pre- and post-operative care will be delivered consistent with our established protocols and standard practices; without regard to surgical approach. This includes a standard preoperative evaluation and patient education period followed by surgery. After surgery, patients are usually discharged from the hospital within the first 24 hours. Follow-up of patients will include an initial post-discharge clinic visit within the first 2 weeks, and subsequent visits scheduled at the time intervals as listed above. Subjects will be followed for a period of approximately 12 months.

This study compares a modified bariatric surgical approach. PLAGB will be studied and compared to the SLAGB procedure through a prospective randomized clinical trial.

Please note: Per our FDA approved modification of 6/18/2014, all study specific testing was eliminated, and only safety assessments were completed in the surgical office at 6 months and 1 year after surgery.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 17 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: Single (Participant)
• Primary Purpose: Treatment
• Official Title: Multicenter Prospective Randomized Clinical Trial of Plicated Laparoscopic Adjustable Gastric Banding
• Study Start Date: September 2013
• Actual Primary Completion Date: April 2015
• Actual Study Completion Date: April 2015

Arms and Interventions

Arm	Intervention/treatment
Active Comparator: Standard-LAGB; Subjects will be blinded and randomly assigned to the Standard Laparoscopic Gastric Banding(SLAGB)arm of the study. These subjects will receive the standard of care or standard laparoscopic gastric banding surgery.Subjects will be followed for a period of approximately 36 months.	Device: Standard-LAGB; The laparoscopic adjustable gastric banding (LAGB) procedure is a safe, effective, and durable treatment option for refractory morbid obesity and its related health consequences.5 This minimally invasive technique is now a popular approach for bariatric surgery, and it offers obvious advantages such as decreased operating time, shorter hospital stay (often same day surgery), and favorable complication rates as compared with other bariatric procedures.; Other Name: Standard Laparoscopic Adjustable Gastric Banding Surgery
Experimental: Plicated-LAGB; Subjects will be blinded and randomly assigned to the Plicated Laparoscopic Gastric Banding(PLAGB)arm of the study. These subjects will receive the plicated laparoscopic gastric banding surgery with involves the placement of plication sutures to "anchor" the redundant stomach around the newly placed device. Subjects will be followed for a period of approximately 36 months.	Device: Plicated-LAGB; At the time of LAGB placement, plication sutures can be placed along the body & greater curvature of the stomach to "tighten" and "cinch up" the stomach in a sleeve-like orientation. It was recently reported that this modified technique of plicated LAGB could result in lower band slippage complication rates and faster, early weight loss.; Other Name: Plicated Laparoscopic Adjustable Gastric Banding Surgery

Outcome Measures

Primary Outcome Measures :

1. Weight Loss [ Time Frame: 36 months ]

Secondary Outcome Measures :

1. Quality of Life [ Time Frame: 36 months ]
2. Quantitative Change in Hypertension [ Time Frame: 36 months ]
   Systolic and Diastolic Blood Pressure will be measured over the scheduled visits and the change in preoperative and postoperative blood pressure will be determined. We will also assess the need for medications to treat hypertension before and after surgery.
3. Quantitative Change in Diabetes [ Time Frame: 36 months ]
   Blood Sugar will be measured over the scheduled visits and the change in preoperative and postoperative glucose levels will be determined. We will also assess the need for medications to treat diabetes before and after surgery.
4. Quantitative Change in Hyperlipidemia [ Time Frame: 36 months ]
   Lipid levels will be measured annually for 3 years and the change in preoperative and postoperative levels will be determined. We will also assess the need for medications to treat hyperlipidemia before and after surgery.
5. Quantitative Change in Hypertriglyceridemia [ Time Frame: 36 months ]
   Triglyceride levels will be measured annually for 3 years and the change in preoperative and postoperative levels will be determined. We will also assess the need for medications to treat hypertriglyceridemia before and after surgery.

Eligibility Criteria

• Ages Eligible for Study: 18 Years to 60 Years (Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria: Subjects must meet the following criteria to be eligible for study entry:

1. Age between 18-60 years,
2. Morbidly obese:

a. BMI > 40, or b. BMI > 35 + co-morbid obesity related disease condition c)BMI < or equal to 55

Exclusion Criteria: Subjects meeting the following criteria will be excluded from study entry:

1. Patients with any major medical problems contraindicating surgery (eg.myocardial infarct within last 6 months, cancer within last 5 years, end stage renal/liver disease, etc.)
2. Patients with a medically treatable cause of obesity (eg. untreated hypothyroidism, Prader-Willi, etc.)
3. Patients who elect to undergo a surgery other than a PLAGB or SLAGB
4. Patient who is unwilling to be randomized to PLAGB or SLAGB
5. Pregnant or planning pregnancy within 12 months
6. Alcohol or drug addiction
7. Established infection anywhere in the body at the time of surgery
8. Previous history of bariatric surgery, gastric surgery, intestinal obstruction, or adhesive peritonitis.
9. Family or patient history of autoimmune disease
10. Hiatal Hernia > 3cm (as reported per radiology on pre-operative swallow study)

Contacts and Locations

Locations

United States, Pennsylvania

University of Pittsburgh Medical Center

Pittsburgh, Pennsylvania, United States, 15213

Sponsors and Collaborators

Dana Portenier, MD

Allergan

Investigators

• Principal Investigator: Dana D Portenier, MD; Duke University
• Principal Investigator: Carol McCloskey, MD; University of Pittsburgh Medical Center

More Information

Publications:

Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999-2008. JAMA. 2010 Jan 20;303(3):235-41. doi: 10.1001/jama.2009.2014. Epub 2010 Jan 13.

Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004 Oct 13;292(14):1724-37. Review. Erratum in: JAMA. 2005 Apr 13;293(14):1728.

Sjöström L, Narbro K, Sjöström CD, Karason K, Larsson B, Wedel H, Lystig T, Sullivan M, Bouchard C, Carlsson B, Bengtsson C, Dahlgren S, Gummesson A, Jacobson P, Karlsson J, Lindroos AK, Lönroth H, Näslund I, Olbers T, Stenlöf K, Torgerson J, Agren G, Carlsson LM; Swedish Obese Subjects Study. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007 Aug 23;357(8):741-52.

Pories WJ. Bariatric surgery: risks and rewards. J Clin Endocrinol Metab. 2008 Nov;93(11 Suppl 1):S89-96. doi: 10.1210/jc.2008-1641. Review.

Longitudinal Assessment of Bariatric Surgery (LABS) Consortium, Flum DR, Belle SH, King WC, Wahed AS, Berk P, Chapman W, Pories W, Courcoulas A, McCloskey C, Mitchell J, Patterson E, Pomp A, Staten MA, Yanovski SZ, Thirlby R, Wolfe B. Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med. 2009 Jul 30;361(5):445-54. doi: 10.1056/NEJMoa0901836.

Gravante G, Araco A, Araco F, Delogu D, De Lorenzo A, Cervelli V. Laparoscopic adjustable gastric bandings: a prospective randomized study of 400 operations performed with 2 different devices. Arch Surg. 2007 Oct;142(10):958-61.

Cottam DR, Atkinson J, Anderson A, Grace B, Fisher B. A case-controlled matched-pair cohort study of laparoscopic Roux-en-Y gastric bypass and Lap-Band patients in a single US center with three-year follow-up. Obes Surg. 2006 May;16(5):534-40.

Hussain A, Mahmood H, El-Hasani S. Gastric plication can reduce slippage rate after laparoscopic gastric banding. JSLS. 2010 Apr-Jun;14(2):221-7. doi: 10.4293/108680810X12785289144241.

Lee CM, Cirangle PT, Jossart GH. Vertical gastrectomy for morbid obesity in 216 patients: report of two-year results. Surg Endosc. 2007 Oct;21(10):1810-6. Epub 2007 Mar 14.

Lancaster RT, Hutter MM. Bands and bypasses: 30-day morbidity and mortality of bariatric surgical procedures as assessed by prospective, multi-center, risk-adjusted ACS-NSQIP data. Surg Endosc. 2008 Dec;22(12):2554-63. doi: 10.1007/s00464-008-0074-y. Epub 2008 Sep 20.

• Responsible Party: Dana Portenier, MD, Assistant Professor, Duke University
• ClinicalTrials.gov Identifier: NCT01564732
• Other Study ID Numbers: Pro00033638
• First Posted: March 28, 2012
• Results First Posted: June 1, 2016
• Last Update Posted: July 1, 2016
• Last Verified: June 2016

Keywords provided by Dana Portenier, MD, Duke University:

morbid obesity; gastric band

Additional relevant MeSH terms:

Obesity, Morbid; Obesity; Overnutrition; Nutrition Disorders; Overweight; Body Weight