Clinical trial NCT01419769: AXIOS Stent & Delivery System Study
Official title: A Prospective, Multi-center, Non-blinded, Single-arm (Nonrandomized) Study of the AXIOS Stent and Delivery System
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Pancreatic Pseudocyst(s)
Keywords: symptomatic pancreatic pseudocyst
pancreatic pseudocyst
transluminal drainage
minimally invasive
Nitinol stent
transmural endoscopic drainage
catheter based
Lead sponsor: Xlumena, Inc.
Sponsor class: INDUSTRY
First posted: 2011-08-18
Enrollment: 30
Sex: ALL
Minimum age (years): 18
Maximum age (years): 75
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: TREATMENT

Brief summary: The Xlumena AXIOS Stent and Delivery System is an investigational device in the USA, and this study is being conducted under an Investigational Device Exemption (IDE) granted by the US Food and Drug Administration (FDA).

The study design is prospective, multi-center, non-blinded, single-arm (nonrandomized) study. Up to 10 sites in the United States, European Community and/or Japan will enroll a total of 24 patients. A majority of the patients will be enrolled in the United States.

Patients will be followed at (approximately) 30 days and/or 60 days depending upon pseudocyst resolution confirmation, at 1-week post-stent removal,and possibly at 3 and 6 month post-stent removal.

Detailed description: OBJECTIVE:

To demonstrate the safety and effectiveness of the Xlumena AXIOS Stent and Delivery System for endoscopic drainage of pancreatic pseudocysts in patients with symptomatic pancreatic pseudocysts that are greater than or equal to 6 cm (≥6cm) in diameter, have ≥ 70% fluid contents and are adherent to the bowel wall.

STUDY DESIGN:

Prospective, multi-center, non-blinded, single-arm (nonrandomized) study

KEY ENDPOINTS:

Safety: The safety endpoint is freedom from major complications through the duration of the 1-week post-stent removal study period, defined as:

1. Access site-related bleeding requiring transfusion;
2. Access site-related infection requiring intravenous or intramuscular antibiotics and/or extended hospitalization;
3. Surgery for access-site related perforation;
4. Stent migration/dislodgement into the pseudocyst or enteral lumen;
5. Tissue injury, defined as ulceration to the submucosa at site of stent implant as observed to persist through 1-week post-stent removal.
6. Serious adverse event classified as implant-associated or implant/endoscopic procedure-associated;

Effectiveness:

1. Stent lumen patency at 30 days and/or 60 days
2. Stent removability at 30 days and/ or 60 days.
3. Technical success, defined as: placement of the AXIOS stent using the AXIOS delivery system and removal of the AXIOS stent using a standard endoscopic snare.
4. Clinical success, defined as: at least a 50% decrease in pseudocyst size, based on radiographic analysis, at 30 days and/or 60 days.

PATIENT POPULATION:

Patients between 18 and 75 years of age, suitable for transluminal drainage of symptomatic pancreatic pseudocysts that are greater than or equal to 6 cm in diameter and adherent to the bowel wall are candidates for study treatment.

FOLLOW-UP SCHEDULE:

Clinical follow-up evaluations of study endpoints will be conducted at 30 days and/or 60 days, 1 week post stent removal and possibly at 3 and 6 months post stent removal.

PLANNED NUMBER OF PATIENTS, SITES \& REGIONS:

The target enrollment for the study is 24 subjects. Study will be conducted at up to 10 investigational sites in the United States, Japan and/or the European Community. A majority of the patients will be enrolled in the United States.

Eligibility criteria: Inclusion Criteria:

* (patients must meet all criteria)

  1. Age between 18 and 75 years old, male or female.
  2. Eligible for endoscopic intervention.
  3. Acceptable candidate for endoscopic transluminal pancreatic pseudocyst drainage
  4. Symptomatic pancreatic pseudocyst having the following characteristics:

     * Greater than or equal to 6 cm in size (based upon the maximum crosssectional area in the CT scan),
     * Adherent to bowel wall, and
     * ≥70% fluid content
  5. Patient understands the study requirements and the treatment procedures and provides written Informed Consent using a form that has been approved by the local Institutional Review Board or Ethics Committee before any study-specific tests or procedures are performed.
  6. Patient is willing to comply with all specified follow-up evaluations, including willingness to undergo a pre/post CT imaging study.

Exclusion Criteria:

* (patients meeting any of the below criteria will be excluded from study)

  1. \<18 or \>75 years of age
  2. Pancreatic pseudocysts having the following characteristics:

     * Require nasocystic drainage,
     * \< 69% fluid content
  3. The fluid collection to be drained is an immature pseudocyst
  4. The fluid collection to be drained is a cystic neoplasm
  5. The fluid collection to be drained is a pseudoaneurysm
  6. The fluid collection to be drained is a duplication cyst
  7. The fluid collection to be drained is a non-inflammatory fluid collection
  8. There is more than one pseudocyst requiring drainage
  9. Abnormal coagulation:

     * INR \> 1.5 and not correctable
     * presence of a bleeding disorder
     * platelets \< 50,000/mm3
  10. Altered anatomy that precludes the physician's ability to deliver the stent (decision on a case by case basis).
  11. Intervening gastric varices or vessels within a one centimeter radius of the needle (visible using endoscopy or endoscopic ultrasound)
  12. Any prior true anaphylactic reaction to contrast agents, nitinol (nickel titanium), silicone or any other materials contacting the patient.
  13. Female of childbearing potential with a positive pregnancy test prior to the procedure or intends to become pregnant during the study.
  14. Currently participating in another investigational drug of device study that has not completed the primary endpoint or that clinically interferes with the endpoints of this study.

Primary outcomes:
measure: Safety - Freedom From Major Complications: Access Site-related Bleeding
timeFrame: Through the duration of the 1-week post-stent removal study period
measure: Safety - Freedom From Major Complications: Access Site-related Infection
timeFrame: Through the duration of the 1-week post-stent removal study period
measure: Safety - Freedom From Major Complications: Perforation
timeFrame: Through the duration of the 1-week post-stent removal study period
measure: Safety - Freedom From Major Complications: Stent Migration/Dislodement
timeFrame: Through the duration of the 1-week post-stent removal study period
measure: Safety - Freedom From Major Complications: Tissue Injury
timeFrame: Through the duration of the 1-week post-stent removal study period
measure: Safety - Freedom From Major Complications: SAE's
timeFrame: Through the duration of the 1-week post-stent removal study period
Secondary outcomes:
measure: Effectiveness: Stent Lumen Patency at 30 Days and/or 60 Days
timeFrame: Up to 60 days
measure: Effectiveness: Stent Removability at 30 Days and/or 60 Days
timeFrame: Up to 60 days
measure: Effectiveness: Technical Success
timeFrame: Up to 60 days
measure: Clinical Success
timeFrame: Up to 60 days
Other outcomes:
Locations:
city: San Francisco
country: United States
facility: California Pacific Medical Center (CPMC)
state: California
city: Aurora
country: United States
facility: Unversity of Colorado Denver
state: Colorado
city: Jacksonville
country: United States
facility: Borland-Groover Clinic
state: Florida
city: Chicago
country: United States
facility: University of Chicago Medical Center (UCMC)
state: Illinois
city: New York
country: United States
facility: Cornell University
state: New York
city: Philadelphia
country: United States
facility: Thomas Jefferson University
state: Pennsylvania
city: Marbella
country: Spain
facility: Hospital Costa del Sol
Study officials:
References:
citation: Shah RJ, Shah JN, Waxman I, Kowalski TE, Sanchez-Yague A, Nieto J, Brauer BC, Gaidhane M, Kahaleh M. Safety and efficacy of endoscopic ultrasound-guided drainage of pancreatic fluid collections with lumen-apposing covered self-expanding metal stents. Clin Gastroenterol Hepatol. 2015 Apr;13(4):747-52. doi: 10.1016/j.cgh.2014.09.047. Epub 2014 Oct 5.