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Randomized EsophyX Versus Sham / Placebo Controlled TIF Trial: The RESPECT Study (RESPECT)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01136980
Recruitment Status : Completed
First Posted : June 4, 2010
Last Update Posted : March 6, 2019
Information provided by (Responsible Party):
EndoGastric Solutions

Brief Summary:
The objective of the study is to evaluate the relative merits, safety and effectiveness of the EsophyX transoral device in performing an advanced TIF procedure in patients with "troublesome symptoms" as defined by the Montreal consensus definition while on PPIs compared with sham and placebo controls.

Condition or disease Intervention/treatment Phase
Gastroesophageal Reflux Disease Hiatal Hernia Device: TIF Transoral Fundoplication Other: Sham placebo procedure Not Applicable

Detailed Description:

Primary Effectiveness Endpoint: A clinically significant reduction in GERD symptoms, specifically "Troublesome" regurgitation with or without heartburn assessed by the Reflux Disease Questionnaire (RDQ).

Troublesome symptoms are those which occur a minimum of 2 days a week and are at least moderate in severity.

Secondary Effectiveness Endpoint: The normalization of esophageal acid exposure at 6 months and a clinically significant reduction in PPI usage at 12 months.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 129 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Participant)
Primary Purpose: Treatment
Official Title: A Randomized Controlled Trial Comparing Transoral Incisionless Fundoplication (TIF) Using EsophyX With Sham Procedure for the Treatment of PPI Dependent GERD Compared With Sham and Placebo Controls
Study Start Date : April 2011
Actual Primary Completion Date : April 2015
Actual Study Completion Date : March 2018

Resource links provided by the National Library of Medicine

MedlinePlus related topics: GERD

Arm Intervention/treatment
Placebo Comparator: Sham placebo procedure
Sham Procedure: SHAM/PPI's An upper GI Endoscopy is performed with a standard endoscope, during 30-45 minutes. The patient is under general anesthesia. EGD explores the esophagus, the stomach, and the GEJ.
Other: Sham placebo procedure
The Sham Procedure (control) will consist of an upper GI endoscopy that will be conducted under general anesthesia in an operating room. The surgical team will follow the same steps before, during, and after the sham procedure similar to the TIF procedure, except they will never insert the EsophyX device into the patient. The endoscope will be manipulated for 30-45 min as if the device were around it to simulate the effect of many rotations and manipulations on the esophagus.
Other Name: Sham Procedure

Active Comparator: TIF Transoral Fundoplication
Intervention: TIF 2.0/Placebo TIF Transoral Incisionless Fundoplication: A fundoplication of 270 degrees and 3cm in length was created. The EsophyX device is introduced over a standard endoscope, through the mouth, into the stomach.
Device: TIF Transoral Fundoplication
A novel surgical technique that creates a gastric fundoplication and restores competency of the gastroesophageal valve now exists for patients who have limited anatomic defects (small hiatal hernia). This technique is performed transorally using the EsophyX device (EndoGastric Solutions, Inc. Redmond, WA, USA) recreates a gastric fundoplication at the gastroesophageal junction by creating a flap valve at the intersection of the stomach and the esophagus by deploying polypropylene SerosaFuse fasteners (EndoGastric Solutions)
Other Name: TIF

Primary Outcome Measures :
  1. A clinically significant reduction in GERD symptoms (specifically "Troublesome" regurgitation with or without heartburn as assessed by the RDQ per the Montreal Consensus definition. [ Time Frame: 6 month follow up ]

    Primary efficacy hypothesis 1: At 6-month follow-up, the proportion of TIF2+Placebo pts who are free of "troublesome" symptoms will be statistically significantly larger than those randomized to the Sham+PPI treatment group.

    Secondary efficacy hypothesis 1: At 6-month follow-up, with all patients off PPIs, the proportion of TIF patients with normalized esophageal acid exposure will be statistically significantly higher than the sham group.

Secondary Outcome Measures :
  1. The normalization of esophageal acid exposure and healing of reflux esophagitis [ Time Frame: at 6 months and PPI usage at 12 months. ]
    At 12-month follow-up, ≥ 50% of the patients randomized to TIF will have a clinically significant reduction in PPI consumption as compared with their pre-TIF consumption. Clinical significant reduction is defined as from daily use to occasional use or none at all.

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 80 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Age 18-80 years
  • Dependent upon daily PPIs for > 6 months
  • Troublesome symptoms, specifically heartburn or regurgitation, while on 40 mg of omeprazole or equivalent.

Troublesome heartburn or regurgitation symptoms are those which occur a minimum of 2-3 days a week and are at least moderate in severity.

  • Abnormal ambulatory pH study off PPI therapy for 7 days.
  • Normal or near normal esophageal motility (by manometry)
  • Hiatal hernia axial height is no larger than 2 cm and the transverse dimension should not exceed 2.5 cm
  • Patient willing to cooperate with post-operative dietary recommendations and assessment tests
  • Signed informed consent

Exclusion Criteria:

  • BMI > 35
  • Hiatal hernia > 2 cm
  • Esophagitis Los Angeles grade C or D
  • Esophageal ulcer
  • Esophageal stricture
  • Esophageal motility disorder
  • Pregnancy or plans for pregnancy in the next 12 months (in females)
  • Immunosuppression
  • ASA > 2
  • Portal hypertension and/or varices
  • History of previous resective gastric or esophageal surgery, cervical spine fusion, Zenker's diverticulum, esophageal epiphrenic diverticulum, achalasia, scleroderma or dermatomyositis, eosinophilic esophagitis, or cirrhosis
  • Active gastro-duodenal ulcer disease
  • Gastric outlet obstruction or stenosis
  • Severe gastroparesis or delayed gastric emptying confirmed by solid-phase gastric emptying study if patient complains of postprandial satiety during assessment
  • Coagulation disorders
  • Interprocedural determination of anatomical presentation which in the opinion of the surgeon does not allow safe device introduction.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01136980

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United States, California
Cedars Sinai Medical Center
Los Angeles, California, United States, 90048
United States, Colorado
SurgOne PC
Englewood, Colorado, United States, 80110
United States, Illinois
Northwestern University
Chicago, Illinois, United States, 60611
United States, Ohio
Ohio State University Hospital
Columbus, Ohio, United States, 43211
United States, Oregon
The Oregon Clinic
Portland, Oregon, United States, 97210
Oregon Health and Science University
Portland, Oregon, United States, 97239
United States, Texas
University of Texas, Health Science Center at Houston
Houston, Texas, United States, 77401
United States, Virginia
Reston Surgical Associates
Reston, Virginia, United States, 20190
United States, Washington
University of Washington
Seattle, Washington, United States, 98195
Sponsors and Collaborators
EndoGastric Solutions
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Principal Investigator: John Hunter, MD FACS Oregon Health and Science University
Publications automatically indexed to this study by Identifier (NCT Number):
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Responsible Party: EndoGastric Solutions Identifier: NCT01136980    
Other Study ID Numbers: D01010
First Posted: June 4, 2010    Key Record Dates
Last Update Posted: March 6, 2019
Last Verified: March 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Keywords provided by EndoGastric Solutions:
Anti-reflux surgery
PPI dependent
Additional relevant MeSH terms:
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Gastroesophageal Reflux
Hernia, Hiatal
Pathological Conditions, Anatomical
Esophageal Motility Disorders
Deglutition Disorders
Esophageal Diseases
Gastrointestinal Diseases
Digestive System Diseases
Hernia, Diaphragmatic