The goal of this randomized sham-controlled trial is to ivestigate efficacy and safety of G-POEM in treatment of diabetic gastroparesis and explore impact of G-POEM on glucose metabolism and incretine hormones.
Study Design The study is a single-centre double-blinded sham-controlled randomized trial. All patients have the same baseline characterization. Patients and researchers will be blinded to allocation in trial. Before randomization patients will have an additional meal test performed addressing metabolic characterization of the incretine hormones at baseline. Patients will afterwards be allocated to either the group receiving G-POEM or to the control group where a sham procedure consisting of a gastroscopy with biopsy during general anaesthesia will be done. The randomization will be carried out per-operatively. A computer-generated bloc randomization with sizes of four will be applied. The study will consist of 5 study visits, with a follow-up of 90 days after procedure. Symptoms and adverse event will be monitored 7, 30, and 90 days after intervention. During the 90-day follow-up all primary and secondary outcome will be reassessed. G-POEM procedure is carried out in general anaesthesia in the operating theatre at the Department of Surgery, Hvidovre Hospital. Procedures will be performed by experienced surgeons from the Gastro Unit at Hvidovre Hospital,who postoperatively will have no contact with the research team or study participants. Patients will receive the same care during hospitalization. Patients allocated to sham procedure will have 4 mucosa biopsies from antrum. All biopsies will be handled with formalin and transported to Zealand University Hospital. Here they will be formalin fixed paraffin-embedded and kept in a biobank.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
20
An Endoscopic submucosal tunnel is formed and extended to the first part of the duodenum, followed by a pyloromyotomy, beginning approximately two centimetres proximal to the pylorus and ending in the first part of duodenum.
Endoscopy is performed and tissue samples are collected from fundus and antrum as part of the Sham procedure
Melina Svraka Hansen
Hvidovre, Capital Region, Denmark
RECRUITINGChanges in gastric emptying
assessed by technetium scintigraphy
Time frame: 90 days after intervention
Changes in gastroparesis cardinal symptom index (GCSI)
patient-rated gastroparesis cardinal symptom index score for gastroparesis-related symptoms (naseau, vomiting, early satiety, postprandial fulness, upper abdominal pain). Range from 0-none to 5-very servere.
Time frame: 7, 30 and 90 days after intervention.
Changes in Plasma glucose
concentration of plasma glucose in mmol/L
Time frame: 90 days after intervention.
Changes in postprandial incretinhormones
gastrin, CCK, GIP, GLP-1, GLP-2, glucagon, ghrelin, pancreatic polypeptide (PP)
Time frame: 90 days after intervention.
Concentration of C-peptide in pmol/L
Concentration of C-peptide in pmol/L
Time frame: 90 days after intervention.
Changes in continuous glucose
Measure of 10-days interstitial glucose levels with a Dexcom monitor device attached to the abdominal skin
Time frame: 90 days after intervention.
Incidence of Treatment-Emergent Adverse Events rated by the ASGE lexicon for adverse events
rate and severity of adverse events rated by the ASGE lexicon for adverse events
Time frame: 7,30 and 90 days
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.