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Trial registered on ANZCTR
Registration number
ACTRN12616001247460
Ethics application status
Approved
Date submitted
9/06/2016
Date registered
6/09/2016
Date last updated
6/09/2016
Type of registration
Retrospectively registered
Titles & IDs
Public title
Endoscopic and histologic characterization of esophagogastric neojunction after esophagectomy
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Scientific title
Endoscopic and histologic characterization of esophagogastric neojunction after esophagectomy
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Secondary ID [1]
288886
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None
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Universal Trial Number (UTN)
U1111-1184-0221
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Trial acronym
EHCENE
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Esophagogastric neojunction characterization after esophagectomy
298187
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Prevalence of new cardiac epithelium after esophagectomy
298188
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Condition category
Condition code
Oral and Gastrointestinal
298350
298350
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0
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Other diseases of the mouth, teeth, oesophagus, digestive system including liver and colon
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Cancer
299962
299962
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0
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Oesophageal (gullet)
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Intervention/exposure
Study type
Observational
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Patient registry
False
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Target follow-up duration
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Target follow-up type
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Description of intervention(s) / exposure
All participants have undergone esophagecyomy and then they will perform high definition upper GI endoscopy, and biopsy protocol 3 months after surgery. If cardiac type epithelium could not be identified the procedure will be repeated at, 6 and 12 months.
Each endoscopy will take approximately 15 minutes; the procedure will be performed under deep sedation, and the biopsies will be undertaken to target suspected cardiac mucosa areas and randomly at the anastomosis (4 quadrant biopsies), 2cm above (esophagus) and 2cm below (stomach) the anastomosis.
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Intervention code [1]
294980
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Not applicable
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Comparator / control treatment
None
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Control group
Uncontrolled
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Outcomes
Primary outcome [1]
298560
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To evaluate the prevalence of cardiac type epithelium in the neojunction after esophagectomy (by endoscopic and histological correlation). Histological examination will be performed on biopsy samples collected during endoscopy.
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Assessment method [1]
298560
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Timepoint [1]
298560
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3 months after surgery and if cardiac type epithelium could not be identified the procedure will be repeated at, 6 and 12 months.
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Primary outcome [2]
298561
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To characterize endoscopic and histologically the neojunction (composite primary outcome). The biopsy samples, collected at suspected cardiac mucosa areas and randomly at the anastomosis (4 quadrant biopsies), 2cm above (esophagus) and 2cm below (stomach) the anastomosis will be characterised by hematoxilin-eosin evaluation complemented by immunohistochemistry methods.
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Assessment method [2]
298561
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Timepoint [2]
298561
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3 months after surgery and if cardiac type epithelium could not be identified the procedure will be repeated at, 6 and 12 months.
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Secondary outcome [1]
324584
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To characterize the columnar epithelium phenotype - cardiac, oxintic, oxintic-cardiac and/or intestinal type epithelium - by histological analysis of eosophageal biopsy samples (hematoxilin-eosin evaluation complemented by immunohistochemistry methods)
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Assessment method [1]
324584
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Timepoint [1]
324584
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3 months after surgery and if cardiac type epithelium could not be identified the procedure will be repeated at, 6 and 12 months.
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Secondary outcome [2]
326219
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To evaluate the degree of inflammation.
The degree of inflammation will be assessed by histological analysis of eosophageal biopsy samples (hematoxilin-eosin evaluation), and quantified as mild, moderate or severe/ulceration.
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Assessment method [2]
326219
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Timepoint [2]
326219
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3 months after surgery and if cardiac type epithelium could not be identified the procedure will be repeated at, 6 and 12 months.
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Secondary outcome [3]
326220
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To evaluate the presence of gastroesophageal reflux symptoms.
A questionnaire designed to evaluate the presence and periodicity of gastroesophageal reflux symptoms will be presented for all participants.
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Assessment method [3]
326220
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Timepoint [3]
326220
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In each endoscopy procedure - 3 months after surgery and if cardiac type epithelium could not be identified the procedure and the questionnaire will be repeated at, 6 and 12 months.
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Secondary outcome [4]
327201
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To evaluate the Helicobacter pylori status.
The Helicobacter pylori status will be assessed by histological analysis of gastric biopsy samples (immunohistochemistry methods).
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Assessment method [4]
327201
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Timepoint [4]
327201
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3 months after surgery and if cardiac type epithelium could not be identified the procedure will be repeated at, 6 and 12 months.
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Eligibility
Key inclusion criteria
Patients with esophagogastric anastomosis after esophagectomy with gastric pull-up
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Minimum age
18
Years
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Maximum age
90
Years
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Eastern Cooperative Oncology Group (ECOG) performance status > 2
Upper GI endoscopy and/or sedation contraindications
Patients unable to give informed consent
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Study design
Purpose
Natural history
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Duration
Longitudinal
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Selection
Defined population
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Timing
Prospective
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Statistical methods / analysis
SPSS
T student or Wilcoxon, Chi-square or Fisher's tests. Logistic regression.
No sample size calculation was performed due the the absence of previous studies evaluating the cardiac type ephithelium in neojunctions.
We intend to include approximately 20 patients per year, which represents 50% of the esophagectomy with gastric pull-up performed in our Institution. This percentage was based on the eligibility criteria and the estimated number of patients who agree to be included.
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Recruitment
Recruitment status
Recruiting
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Date of first participant enrolment
Anticipated
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Actual
23/02/2016
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Date of last participant enrolment
Anticipated
28/02/2018
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Actual
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
20
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Accrual to date
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Final
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Recruitment outside Australia
Country [1]
7758
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Portugal
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State/province [1]
7758
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Lisbon
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Funding & Sponsors
Funding source category [1]
293766
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Hospital
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Name [1]
293766
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Instituto Portugues de Oncologia de Lisboa Francisco Gentil
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Address [1]
293766
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Rua Professor Lima Basto,
1099-023 Lisboa
Portugal
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Country [1]
293766
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Portugal
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Primary sponsor type
Hospital
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Name
Instituto Portugues de Oncologia de Lisboa Francisco Gentil
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Address
Rua Professor Lima Basto,
1099-023 Lisboa
Portugal
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Country
Portugal
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Secondary sponsor category [1]
292596
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None
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Name [1]
292596
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None
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Address [1]
292596
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None
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Country [1]
292596
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
294716
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Ethic Comission of Instituto Portugues de Oncologia de Lisboa Francisco Gentil E.P.E.
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Ethics committee address [1]
294716
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Rua Prof. Lima Basto 1099-023 Lisboa Portugal
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Ethics committee country [1]
294716
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Date submitted for ethics approval [1]
294716
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15/12/2015
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Approval date [1]
294716
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28/01/2016
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Ethics approval number [1]
294716
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Summary
Brief summary
In the last decades the incidence of gastro-esophageal junction’s (GEJ) adenocarcinoma has increased dramatically in Western countries. Therefore, the etiopathogenesis and natural history of GEJ pathological processes’ has been subject of extensive research. The definition of cardia is a controversial topic - the nature, location, extent and even the existence of cardiac mucosa is under discussion. Some authors argue that cardia is a native structure (congenital), present from birth; others, favor a metaplastic phenomenon secondary to gastroesophageal reflux. Regardless cardia’s nature, cardiac mucosa can be identified in other locations where its nature is clearly metaplastic: esophagus (in Barrett's esophagus/CLES – columnar lined esophageal segments) and anastomosis after esophagectomy. The esophagectomy with proximal gastric resection and esofagogastrostomy ("gastric pull-up") seems to be the ideal model to study gastric reflux effect on the remaining esophagus and metaplasia development. The presence of cardiac type mucosa in the anastomosis corroborates its acquired nature, instead of a congenital origin. We purpose to develop a prospective, observational, single-center study to evaluate/ characterize endoscopic and histologically the gastro-esophageal neo-junction of patients undergoing esophagectomy with upper polar gastrectomy and "gastric pull-up". We aim to ascertain the possible development of the cardiac type epithelium, reproducing, "in vivo" the natural history of cardiac mucosa. Patients included will perform high definition upper GI endoscopy, and biopsy protocol, at 3, 6 and 12 months, until the columnar epithelium is identified. Additionally, we will evaluate the degree of inflammation, the Helicobacter pylori status and the phenotypic profile of metaplastic columnar epithelium. Patients will also be assessed for the presence of gastroesophageal reflux symptoms.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
63726
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Dr Joana Castela
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Address
63726
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Instituto Portugues de Oncologia de Lisboa Francisco Gentil
Rua Prof. Lima Basto
1099-023 Lisboa
Portugal
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Country
63726
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Portugal
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Phone
63726
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+351916844455
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Fax
63726
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Email
63726
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[email protected]
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Contact person for public queries
Name
63727
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Daniela Vinha Pereira
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Address
63727
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Instituto Portugues de Oncologia de Lisboa Francisco Gentil
Rua Prof. Lima Basto
1099-023 Lisboa
Portugal
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Country
63727
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Portugal
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Phone
63727
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+351966229108
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Fax
63727
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Email
63727
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[email protected]
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Contact person for scientific queries
Name
63728
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Daniela Vinha Pereira
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Address
63728
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Instituto Portugues de Oncologia de Lisboa Francisco Gentil
Rua Prof. Lima Basto
1099-023 Lisboa
Portugal
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Country
63728
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Portugal
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Phone
63728
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+351966229108
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Fax
63728
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Email
63728
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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