Napoleon Measurement for Gastric Bypass Evaluation

Recruiting at 1 trial location

Overseen By Sandy Ng, MD

Age: 18+

Sex: Any

Trial Phase: Phase < 1

Sponsor: NYU Langone Health

Disqualifiers: Prior endoscopy complications

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 1

100 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores a new device called Napoleon (Napoleon Endoscopic Measuring Device) to measure the size of a specific area in the stomach after gastric bypass surgery. It targets patients who have undergone Roux-en-Y gastric bypass surgery and are experiencing weight regain. The trial compares traditional visual estimates of this stomach area with measurements taken using Napoleon to determine if the device provides a more accurate assessment. Individuals who have had this type of surgery and are scheduled for an endoscopy may be suitable candidates for the trial.

As an Early Phase 1 trial, this research focuses on understanding how the Napoleon device functions in people, offering participants a chance to be among the first to benefit from this innovative technology.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What prior data suggests that the Napoleon device is safe for measuring the gastrojejunal anastomosis?

Research has shown that devices like the Napoleon, used in weight-loss procedures, are generally safe. Studies have found that serious side effects occur in less than 5% of cases, indicating that most people tolerate the device well. However, since this trial is in its early stages, specific safety information about the Napoleon may be limited. Prospective participants should discuss these points with the study team. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Napoleon measurement technique because it offers a new way to evaluate patients who have regained weight after undergoing Roux-en-Y gastric bypass surgery. Unlike traditional methods that primarily focus on diet and lifestyle changes, the Napoleon technique uses endoscopy to provide detailed insights into structural changes in the stomach and intestines. This approach could lead to more personalized and effective management strategies for patients struggling with weight regain, addressing an area that current treatments may overlook.

What evidence suggests that the Napoleon device is effective for measuring the gastrojejunal anastomosis?

Research has shown that the Napoleon device, which participants in this trial may experience, is being tested to measure the size of the connection between the stomach and small intestine in patients who have regained weight after a Roux-en-Y gastric bypass. This device aims to provide a more accurate measurement than visual assessment alone. Accurate measurement is important because it can help doctors understand why some patients regain weight after surgery. Although the Napoleon device remains in early testing, researchers hope its precise measurements could improve treatment plans for these patients. It is a promising tool for better understanding and managing weight regain in gastric bypass patients. ^{6 7 8 9 10}

Are You a Good Fit for This Trial?

This trial is for Roux-en-Y gastric bypass patients aged 18-90 who have experienced weight regain and are scheduled for an endoscopy. They must be willing to consent to the study. Those with a history of complications from prior endoscopies cannot participate.

Inclusion Criteria

I had gastric bypass surgery and have gained weight back.

I am willing and able to give my consent for treatment.

I am scheduled for an endoscopy.

Exclusion Criteria

I have had complications from previous endoscopies.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Endoscopy and Measurement

Participants undergo endoscopy where the gastrojejunal anastomosis (GJA) is visually estimated and measured using the Napoleon device

1 day

1 visit (in-person)

Follow-up

Participants are monitored for any immediate post-procedural effects and the ease of use of the Napoleon device is assessed through a survey

1-2 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Napoleon

Trial Overview The Napoleon device's ability to measure the size of gastrojejunal anastomosis in gastric bypass patients is being tested against traditional visual estimation by doctors during endoscopy procedures at two hospitals.

How Is the Trial Designed?

Group I: Roux-en-Y gastric bypass patients with weight regain Experimental Treatment 2 Interventions

The study population is Roux-en-Y gastric bypass (RYGB) patients with weight regain undergoing an endoscopy at Bellevue Hospital Center or Brigham and Women's Hospital.

Who Is Running the Clinical Trial?

NYU Langone Health

Lead Sponsor

Trials

1,431

Recruited

838,000+

Brigham and Women's Hospital

Collaborator

Trials

1,694

Recruited

14,790,000+

Published Research Related to This Trial

Bariatric surgery in France has evolved significantly over 15 years, with adjustable gastric banding and gastric bypass being the most common procedures, each associated with different types of complications.

Gastric bypass tends to have more serious early postoperative complications, while adjustable gastric banding is prone to long-term surgical and mechanical issues, highlighting the importance of long-term follow-up and coordination by general practitioners to manage potential late complications.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Long-term management of patients after bariatric surgery]. Coupaye, M., Ledoux, S., Msika, S.[2016]

The gastric bypass procedure was found to be safe and effective, with a low operative mortality rate of 1% and significant complications in only 10% of the 210 morbidly obese patients studied, all of whom were followed up.

Patients experienced substantial weight loss, averaging a reduction from 289 pounds to 176 pounds at 18 months post-surgery, with over 95% maintaining this weight loss during a 36-month observation period, and notable health improvements in conditions like diabetes and hypertension.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Greenville gastric bypass. Progress report at 3 years. Flickinger, EG., Pories, WJ., Meelheim, HD., et al.[2019]

A modified one-anastomosis gastric bypass was developed for patients with grade 1 and 2 obesity, demonstrating high safety and effectiveness, with all 16 patients achieving a normal BMI within 6 months post-surgery.

The procedure allows for postoperative gastrointestinal examinations without the risk of intestinal malabsorption, making it a reversible option for weight loss surgery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[One-anastomosis gastric bypass with a short limb]. Evdoshenko, VV., Fedenko, VV., Bordan, NS., et al.[2022]

In a study of 235 patients who underwent jejunoiliac bypass for obesity, the operative lethality was 2.1% and 21% experienced postoperative complications, with significant late complications such as liver damage in 15% and electrolyte deficits in 12%.

Among 1585 patients who had various stomach-bypass procedures, the overall postoperative lethality was lower at 1.6%, and 90% reported high satisfaction with the results, while only 5% experienced weight gain after 5 years, indicating the effectiveness of these procedures.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Jejunoileal bypass versus gastric bypass or gastroplasty in the operative treatment of obesity. Scott, HW.[2019]

In a study involving 18 patients undergoing gastric banding, objective measurements of the upper pouch size revealed that surgeons' subjective estimates were significantly smaller than the actual size, indicating a potential risk for inadequate weight loss outcomes.

The findings emphasize the importance of using standardized objective measurements for upper pouch size in gastric surgeries to ensure better evaluation of surgical effectiveness and patient weight loss results.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison between subjective and objective estimates of upper pouch volume at gastric banding for obesity. Granström, L., Backman, L.[2006]

A new method using a fiberoptic endoscope and a Fogarty catheter was developed to accurately measure the gastric outlet size after obesity surgery, proving to be more reliable than traditional endoscopic estimation methods.

The study demonstrated high reproducibility of measurements, indicating that different examiners can achieve consistent results, which is crucial for monitoring post-surgery outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A method for measuring the size of the gastric outlet in obesity surgery. Näslund, I.[2008]

A review of FDA data from January 2017 to November 2020 identified 773 cases involving intragastric balloons, revealing a total of 1134 patient complications, primarily due to device leaks (33.4%).

The most common adverse events reported were vomiting (26.6%), abdominal pain (25.3%), and nausea (15.8%), indicating significant side effects that need to be managed to enhance the effectiveness of this obesity treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Real-World Experience of Intragastric Balloons for Obesity: Insights from the FDA Manufacturer and User Facility Device Experience (MAUDE) Database. Ramai, D., Bhandari, P., Facciorusso, A., et al.[2021]

Diet and exercise alone have not proven effective for sustained weight loss in most obese individuals, while surgical interventions can lead to prolonged weight loss but may result in rebound weight gain over time.

The authors propose a new framework for evaluating medical devices aimed at treating obesity, focusing on a benefit-risk assessment to guide the development and approval of these devices, which was discussed at an FDA workshop and advisory panel.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Benefit-risk paradigm for clinical trial design of obesity devices: FDA proposal. Lerner, H., Whang, J., Nipper, R.[2021]

Using a calibration balloon tube for sizing the pouch and channel during gastroplasty can significantly reduce the time and complications associated with the traditional manometer method, enhancing the safety of the procedure.

This technique effectively addresses three major issues in gastric stapling surgery: ensuring the pouch is appropriately sized, the channel is correctly sized, and preventing postoperative leaks.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Use of a Calibration Balloon Tube to Size the Pouch and Channel in Gastroplasty Procedures. Pingree, JH., Jack, JE.[2019]

The study validated a new guidewire for measuring gastric outlet diameters in patients who have undergone Roux-en-Y gastric bypass, showing high interobserver agreement with an intra-class correlation coefficient of 0.83, similar to the gold standard measurement tool.

Both expert endoscopists and trainees achieved reliable measurements with the new guidewire, indicating that it can be effectively used by practitioners at different skill levels, which may enhance the assessment of patients at risk of weight regain after bariatric surgery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Validation of a new method for the endoscopic measurement of post-bariatric gastric outlet using a standard guidewire: an observer agreement study. de Quadros, LG., Galvão Neto, MD., Campos, JM., et al.[2019]

Citations

1. clinicaltrials.gov clinicaltrials.gov/ct2/show/NCT04832282

Napoleon Measurement of Gastrojejunal Anastomosis This is a clinical trial assessing the feasibility of the Napoleon device for measuring the gastrojejunal anastomosis (GJA). The study population is Roux-en-Y ...

2. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/29082456/

Endoscopic Treatment of Weight Regain Following Roux- ... At 12 months, they were 7.63 ± 4.3 kg, 16.9 ± 11.1%, and 6.6 ± 5.0%, respectively. Subgroup analysis showed that all outcomes were significantly higher in the ...

3. giejournal.org giejournal.org/issue/S0016-5107(20)X0007-1?pageStart=0

July 2020 Argon plasma coagulation alone versus argon plasma coagulation plus full-thickness endoscopic suturing to treat weight regain after Roux-en-Y gastric bypass: a ...

4. onlinelibrary.wiley.com onlinelibrary.wiley.com/doi/10.1111/1753-0407.12878

Endoscopic bariatric and metabolic therapies: Another tool ... Evaluation of an endoscopic suturing device for transoral outlet reduction in patients with weight regain following Roux-en-Y gastric bypass.

5. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC5596836/

Weight regain after Roux-en-Y gastric bypass has a large ... Of 56 RYGB patients, 41 (73%) had weight regain. On average, patients had body mass index (BMI) of 37 ±7.5 kg/m2 and gained 34 ±26% of maximal ...

6. clinicaltrials.gov clinicaltrials.gov/study/NCT04832282

Napoleon Measurement of Gastrojejunal Anastomosis This is a clinical trial assessing the feasibility of the Napoleon device for measuring the gastrojejunal anastomosis (GJA). The study population is Roux-en-Y ...

7. ctv.veeva.com ctv.veeva.com/study/napoleon-measurement-of-gastrojejunal-anastomosis

Napoleon Measurement of Gastrojejunal Anastomosis This is a clinical trial assessing the feasibility of the Napoleon device for measuring the gastrojejunal anastomosis (GJA).

8. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10532500/

Metabolic and Bariatric Endoscopy: A Mini-Review - PMC These devices are broadly safe with serious adverse events (SAEs) < 5%, although some procedures have shown major safety signals (e.g., hepatic ...

9. researchgate.net researchgate.net/publication/373938785_Metabolic_and_Bariatric_Endoscopy_A_Mini-Review

(PDF) Metabolic and Bariatric Endoscopy: A Mini-Review Endoscopic suturing for transoral outlet reduction increases weight loss after Roux-en-Y gastric bypass surgery. Gastroenterology 2013,145 ...

10. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8908793/

Endoscopic versus surgical gastrojejunal revision for ... Endoscopic versus surgical gastrojejunal revision for weight regain in Roux-en-Y gastric bypass patients: 5-year safety and efficacy comparison - PMC.