Management of Malignant Gastric Outlet Obstruction Between Surgery and Endoscopy
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 入组人数
- 250
- 试验地点
- 5
- 主要终点
- Clinical Success
研究概览
简要总结
The aim of this observational study is to compare the outcomes of three different procedures performed for the management of malignant Gastric Outlet Obstruction due to Pancreatic Cancer.
Patients who undergo:
- Surgical gastroenterostomy
- Endoscopic placement of a self-expanding metallic stent
- EUS-guided gastroenterostomy in accordance with standard clinical practice, will be enrolled to evaluate potential differences between the procedures in terms of clinical success, eating experience, chemotherapy tolerance, and nutritional status during follow-up.
Participants will be asked to complete a quality of life questionnaire at baseline and during follow-up; however, no additional procedures will be conducted as a result of participation in the study.
详细描述
Gastric Outlet Obstruction (GOO) syndrome is a frequent complication of biliopancreatic and gastroduodenal neoplasms and manifests with recurrent vomiting, dehydration and malnutrition, seriously compromising quality of life and the ability to tolerate chemotherapy.
Standard treatment options for GOO are surgical gastroenterostomy (S-GE) or endoscopic placement of a self-expanding metallic stent (ES): surgical treatment achieves better long-term results at the cost of a more invasive procedure. The advances of therapeutic endosonography (EUS) have provided a new possibility to resolve this condition through EUS-guided gastroenterostomy (EUS-GE). The latter involves the creation of a gastroenteric bypass by endoscopically positioning a lumen-apposing metal stent (LAMS). Recent evidence has shown several advantages over previous treatments, in terms of less invasiveness compared to surgery and greater long-term efficacy compared to enteral stenting. However, most of the evidence comes from retrospective protocols and heterogeneous studies that include different neoplasms and clinical courses. Furthermore, the definition of clinical success in the current literature refers to the resolution of the mechanical obstruction of the syndrome, without any in-depth study on the clinical impact of different management strategies in terms of more complex outcomes, such as survival, quality of life, nutritional status and chemotherapy tolerance.
The aim of this study is to prospectively analyze the long-term clinical impact of GOO management strategies in a homogeneous cohort of patients with pancreatic adenocarcinoma (PC) and recent disease diagnosis.
The design of this study is:
- Observational
- Prospective
- Multicentric
- Comparative (3-arms)
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •cyto-/histo-logically confirmed pancreatic cancer
- •a maximum of 6 months from pancreatic cancer diagnosis and candidate to active treatment
- •stenosis causing gastric outlet obstruction (GOO) due to neoplastic invasion/compression confirmed by radiology or endoscopy extending from the distal one third of the stomach or the duodenum
- •patients candidate to either ES or EUS-GE or s-GE
排除标准
- •age < 18 years
- •patients with benign or indeterminate gastrointestinal stenosis
- •patients with malignant GOO (mGOO) from neoplasia other than pancreatic cancer
- •candidates to upfront surgical resection or who already received curative pancreatic resection
- •patients who already received a treatment for mGOO
- •patients receiving an additional procedure for biliary drainage which might increase the risk of adverse events or hamper the assessment of quality of life; biliary drainage will be allowed if performed uneventfully (without adverse events) at least one day (endoscopic drainage) or one month (surgical hepaticojejunostomy) before mGOO treatment;
- •patients carrying any percutaneous drainage (such as percutaneous transhepatic biliary drainage or ascites drainage).
- •inability or unwillingness to sign the informed consent form (ICF)
- •contraindications to any active palliation of the mGOO, or indication to palliation through venting gastrostomy or nasogastric tube placement alone
结局指标
主要结局
Clinical Success
时间窗: 30 days
A Gastric Outlet Obstruction Scoring System (GOOSS) \>/= 2 after the initial intervention, corresponding to the ability to eat at least soft solids
次要结局
- Chemotherapy Tolerance(24 months)
- Nutritional status(6 months)
- Body Mass Index(6 months)
- Eating Experience(3 months)
- Body Composition(6 months)
研究者
Giuseppe Vanella
Principal Investigator
IRCCS San Raffaele