Endoscopic Sleeve Gastroplasty With Endomina® for the Treatment of Obesity in Kidney Transplant Candidates

Fondazione Policlinico Universitario Agostino Gemelli IRCCS24 enrolled

Overview

The aim of this pilot prospective interventional study is to evaluate the efficacy of endoscopic sleeve gastroplasty (ESG) in allowing obese subjects (≥35 kg/m2) with end stage renal disease who need of kidney transplantation to reduce their BMI below 35 in order to be inserted in the waiting list BMI. The main question\[s\] it aims to answer are: Is the procedure effective in reducing BMI to the target level in 12 months? Which is the effect on weight loss, quality of life and obesity-related comorbidities? Participants will undergo ESG as per standard clinical practice and followed up to 12 months before transplantation and for 12 months after transplantation.

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Obesity, Morbid End Stage Renal Disease Kidney Transplantation Endoscopic Sleeve Gastroplasty

Interventions

Endoscopic Sleeve Gastroplasty (ESG)PROCEDURE

ESG will be performed under general anaesthesia with orotracheal intubation. The Endomina® suturing system (EndoTools Therapeutics S.A., Gosselies, Belgium) mounted on a single channel endoscope (GIF-H190/GIF-HQ190; Olympus Medical Systems Corp., Tokyo, Japan) will be used. This system allows to obtain full thickness gastric sutures through the gastric wall of the gastric body, leaving the antrum and the gastric fundus free. The ESG starts with the reduction of the gastric body, suturing from distal to proximal and starting from the notch of the angulus and ending at the level of the fundus. 4-8 full thickness stitches will be placed, with 2 passes per stitch. The final effect of ESG is the creation of a gastric tubule thus reducing the volume of the stomach. After the procedure, the final shape will be evaluated, to examine any gaps that would require additional closure, and to exclude bleedings and/or other complications.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 70 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Adult patients (i.e., age between 18 and 70 years). * BMI ≥ 35 kg/m²; * Patients with chronic kidney disease (CKD) G4-G5 (glomerular filtration rate \[GFR\] \<30ml/min/1.73 m2) who are expected to reach end-stage kidney disease (ESKD) at least 6 to 12 months before anticipated dialysis initiation (pre-emptive transplant candidates) or patients already on haemodialysis when medically stable and kidney failure deemed irreversible; * Patients not listed because of a high BMI according to the policy of the transplant Centre (cut-off 35 kg/m2); * Signed informed consent. Exclusion Criteria: * Patients on peritoneal dialysis * Upper gastro-intestinal bleeding (gastric or oesophageal) in the previous six months; * Ongoing or active malignancy during the last 5 years * Myocardial infarction during the past 6 months or/and heart failure class III or IV according to the New York Heart association's classification; * Previous stomach, oesophagus or duodenum surgery; * Technical non-feasibility in the opinion of the endoscopist; * Clinical signs of active infection; * Concomitant unstoppable anticoagulant or anti platelet therapy, except for low dose aspirin (≤ 100 mg); * Active drugs or alcohol abuse; * Pregnancy, lactation (desire to become pregnant during study duration); * Enrolment in other clinical studies; * Contraindication to general anaesthesia; * Other conditions to exclude the subject in investigators opinion; * Refusal to sign informed consent. -

Outcomes

Primary Outcomes

Kidney transplant list inclusion

number of patients who achieve a BMI \< 35 kg/m² within 12 months post-ESG, allowing them to be included in the kidney transplant list

Time frame: 12 months