Clinical trial NCT00816179: Diagnostic Endoscopic Exploration for Pancreatic Head Mass
Official title: Human Clinical Trial of Diagnostic Transgastric Endoscopic Peritoneoscopy for Staging of Pancreatic Head Mass
Study type: INTERVENTIONAL
Overall status: TERMINATED
Phase: NA
Conditions: Pancreatic Head Mass
Keywords: Pancreatic head mass
Pancreatic cancer
NOTES
Endoscopic peritoneoscopy
Whipple
palliative gastrojejunostomy
Lead sponsor: Ohio State University
Sponsor class: OTHER
Collaborators: name: Natural Orifice Surgery Consortium for Assessment and Research
First posted: 2008-12-31
Enrollment: 11
Sex: ALL
Minimum age (years): 18
Maximum age (years): 80
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: DIAGNOSTIC

Brief summary: This study is being done to find out if an endoscope passed down the throat, through the stomach, and into the abdomen can quickly and accurately examine the organs and tissue of the abdomen and take biopsies if needed.

Detailed description: This study is being done to find out if an endoscope (a small, flexible tube with a camera mounted on the end) passed down the throat, through the stomach, and into the abdomen can quickly and accurately examine the organs and tissue of the abdomen and take biopsies if needed. We wish to determine if this endoscopic route is as fast and efficient as the laparoscopic route, which is the current standard of care.

Eligibility criteria: Inclusion Criteria:

* Age range 18-80
* Radiographic diagnosis of resectable pancreatic head mass presumed to be pancreatic adenocarcinoma

Exclusion Criteria:

* Inability to obtain informed consent
* Pregnancy
* Intra-abdominal adhesions that preclude endoscopy
* Contraindication to upper endoscopy such as stricture, stenosis of the foregut
* Previous gastric surgery
* Diagnosis of pancreatic body or tail tumor
* History or current diagnosis of gastric ulcer
* Metastatic disease diagnosed by CT, EUS, MRI, or nuclear imaging
* Patient is not a candidate for resection based upon CT, EUS, MRI, or nuclear imaging
* Antiplatelet medication not stopped at least 7 days prior to procedure
* Anticoagulant medication not stopped at least 5 days prior to procedure

Primary outcomes:
measure: Endoscopically visualize the abdominal cavity to determine absence or presence of metastatic lesions to successfully stage pancreatic head malignancies and direct surgical treatment.
timeFrame: Intraoperatively
Secondary outcomes:
measure: Comparison of laparoscopic exploration (retrospectively) to endoscopic exploration.
timeFrame: 1 year
measure: Ability to obtain peritoneal biopsies when appropriate during transgastric endoscopic procedures.
timeFrame: Intraoperatively
Other outcomes:
Locations:
city: Columbus
country: United States
facility: The Ohio State University Medical Center
state: Ohio
Study officials:
affiliation: OSUMC
name: Jeffrey W Hazey, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Rattner D, Kalloo A; ASGE/SAGES Working Group. ASGE/SAGES Working Group on Natural Orifice Translumenal Endoscopic Surgery. October 2005. Surg Endosc. 2006 Feb;20(2):329-33. doi: 10.1007/s00464-005-3006-0. No abstract available.
citation: White R, Winston C, Gonen M, D'Angelica M, Jarnagin W, Fong Y, Conlon K, Brennan M, Allen P. Current utility of staging laparoscopy for pancreatic and peripancreatic neoplasms. J Am Coll Surg. 2008 Mar;206(3):445-50. doi: 10.1016/j.jamcollsurg.2007.09.021. Epub 2007 Nov 26.
citation: Lillemoe KD, Cameron JL, Hardacre JM, Sohn TA, Sauter PK, Coleman J, Pitt HA, Yeo CJ. Is prophylactic gastrojejunostomy indicated for unresectable periampullary cancer? A prospective randomized trial. Ann Surg. 1999 Sep;230(3):322-8; discussion 328-30. doi: 10.1097/00000658-199909000-00005.
citation: Ponsky JL. Gastroenterologists as surgeons: what they need to know. Gastrointest Endosc. 2005 Mar;61(3):454. doi: 10.1016/s0016-5107(04)02632-x. No abstract available.
citation: Wagh MS, Merrifield BF, Thompson CC. Endoscopic transgastric abdominal exploration and organ resection: initial experience in a porcine model. Clin Gastroenterol Hepatol. 2005 Sep;3(9):892-6. doi: 10.1016/s1542-3565(05)00296-x.
citation: Merrifield BF, Wagh MS, Thompson CC. Peroral transgastric organ resection: a feasibility study in pigs. Gastrointest Endosc. 2006 Apr;63(4):693-7. doi: 10.1016/j.gie.2005.11.043.
citation: Kalloo AN, Singh VK, Jagannath SB, Niiyama H, Hill SL, Vaughn CA, Magee CA, Kantsevoy SV. Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Gastrointest Endosc. 2004 Jul;60(1):114-7. doi: 10.1016/s0016-5107(04)01309-4.
citation: Ikeda K, Fritscher-Ravens A, Mosse CA, Mills T, Tajiri H, Swain CP. Endoscopic full-thickness resection with sutured closure in a porcine model. Gastrointest Endosc. 2005 Jul;62(1):122-9. doi: 10.1016/s0016-5107(05)00517-1.
citation: Onders RP, McGee MF, Marks J, Chak A, Rosen MJ, Ignagni A, Faulx A, Schomisch S, Ponsky J. Natural orifice transluminal endoscopic surgery (NOTES) as a diagnostic tool in the intensive care unit. Surg Endosc. 2007 Apr;21(4):681-3. doi: 10.1007/s00464-007-9214-z. Epub 2007 Feb 16.
citation: Lima E, Rolanda C, Pego JM, Henriques-Coelho T, Silva D, Carvalho JL, Correia-Pinto J. Transvesical endoscopic peritoneoscopy: a novel 5 mm port for intra-abdominal scarless surgery. J Urol. 2006 Aug;176(2):802-5. doi: 10.1016/j.juro.2006.03.075.
citation: McGee MF, Rosen MJ, Marks J, Chak A, Onders R, Faulx A, Ignagni A, Schomisch S, Ponsky J. A reliable method for monitoring intraabdominal pressure during natural orifice translumenal endoscopic surgery. Surg Endosc. 2007 Apr;21(4):672-6. doi: 10.1007/s00464-006-9124-5. Epub 2007 Feb 7.
citation: Kantsevoy SV, Hu B, Jagannath SB, Vaughn CA, Beitler DM, Chung SS, Cotton PB, Gostout CJ, Hawes RH, Pasricha PJ, Magee CA, Pipitone LJ, Talamini MA, Kalloo AN. Transgastric endoscopic splenectomy: is it possible? Surg Endosc. 2006 Mar;20(3):522-5. doi: 10.1007/s00464-005-0263-x. Epub 2006 Jan 21.
citation: Kantsevoy SV, Jagannath SB, Niiyama H, Chung SS, Cotton PB, Gostout CJ, Hawes RH, Pasricha PJ, Magee CA, Vaughn CA, Barlow D, Shimonaka H, Kalloo AN. Endoscopic gastrojejunostomy with survival in a porcine model. Gastrointest Endosc. 2005 Aug;62(2):287-92. doi: 10.1016/s0016-5107(05)01565-8.
citation: Bergstrom M, Ikeda K, Swain P, Park PO. Transgastric anastomosis by using flexible endoscopy in a porcine model (with video). Gastrointest Endosc. 2006 Feb;63(2):307-12. doi: 10.1016/j.gie.2005.09.035.
citation: Park PO, Bergstrom M, Ikeda K, Fritscher-Ravens A, Swain P. Experimental studies of transgastric gallbladder surgery: cholecystectomy and cholecystogastric anastomosis (videos). Gastrointest Endosc. 2005 Apr;61(4):601-6. doi: 10.1016/s0016-5107(04)02774-9.
citation: Pai RD, Fong DG, Bundga ME, Odze RD, Rattner DW, Thompson CC. Transcolonic endoscopic cholecystectomy: a NOTES survival study in a porcine model (with video). Gastrointest Endosc. 2006 Sep;64(3):428-34. doi: 10.1016/j.gie.2006.06.079.
citation: Jagannath SB, Kantsevoy SV, Vaughn CA, Chung SS, Cotton PB, Gostout CJ, Hawes RH, Pasricha PJ, Scorpio DG, Magee CA, Pipitone LJ, Kalloo AN. Peroral transgastric endoscopic ligation of fallopian tubes with long-term survival in a porcine model. Gastrointest Endosc. 2005 Mar;61(3):449-53. doi: 10.1016/s0016-5107(04)02828-7.
citation: Wagh MS, Merrifield BF, Thompson CC. Survival studies after endoscopic transgastric oophorectomy and tubectomy in a porcine model. Gastrointest Endosc. 2006 Mar;63(3):473-8. doi: 10.1016/j.gie.2005.06.045.
citation: Sclabas GM, Swain P, Swanstrom LL. Endoluminal methods for gastrotomy closure in natural orifice transenteric surgery (NOTES). Surg Innov. 2006 Mar;13(1):23-30. doi: 10.1177/155335060601300105.
citation: Ko CW, Kalloo AN. Per-oral transgastric abdominal surgery. Chin J Dig Dis. 2006;7(2):67-70. doi: 10.1111/j.1443-9573.2006.00256.x.