A UK Registry for Metabolic and Bariatric Endoscopic Interventions

Overview

In the UK alone, obesity is a major health problem with more than one quarter of adults estimated to be obese. Obesity promotes the development of many serious diseases including diabetes, heart disease, kidney disease, and increased risk of some cancers. Patients living with obesity also suffer from significant symptoms that impact their life including shortness of breath, back pain, poor mobility, and poor mental health. Traditional methods to help lose weight include low calorie diets and increased exercise. These may be effective in the short-term, but due to powerful biological mechanisms they are hard to maintain over the long-term and most individuals are unable to achieve normal weight. This means many people may need bariatric surgery that is highly effective at lowering body weight, but it is associated with complications and not all patients will want or be able to undergo surgery. This has led to the development of many new obesity treatments that are completed with an endoscope. An endoscope is a thin flexible tube that has a camera at the end. It is inserted through the mouth and into the stomach and small bowel. There are various procedures that can be done at the time of endoscopy that have been shown to be effective with a low number of side-effects. These are still relatively new compared to more traditional treatments and only a small number of doctors can perform them within the UK. Due to these limitations, the aim of this registry is to obtain real-world information on the safety and effectiveness of these procedures across the UK. The investigators hope over time this will improve the knowledge of clinicians about treating obesity with endoscopy and support future access and funding to these treatments.

Detailed description

This is a national, multi-centre, prospective, UK registry that aims to determine the safety and efficacy of metabolic and bariatric endoscopic procedures used in the treatment of obesity and related complications. The investigators will do this by determining the effect of primary bariatric procedures (gastroplasty, intragastric balloons (IGB)), revisional bariatric procedures (Transoral outlet reduction endoscopy (TORe), gastroplasty revision), and primary metabolic procedures (Duodenal Mucosal Resurfacing (DMR)), completed by endoscopists within the UK.

The objective of this registry is to collect demographic, procedural and follow-up outcome data on the use of metabolic and bariatric endoscopic procedures in patients with obesity and/or obesity-related complications. This registry will provide real-life outcomes on the use of these novel endoscopic devices from multiple centres participating across the UK to provide longer-term safety and efficacy data. In addition, the registry will enable development of a UK-wide research network to support further research, innovation, and training into metabolic and bariatric endoscopy.

Interventions

• Device Endoscopic gastric suturing
  Endoscopic suturing of the stomach to reduce volume and promote weight loss with either the Apollo Overstitch or Overstitch Sx system.
• Device Endoscopic gastric plication
  Endoscopic plication of the stomach to reduce volume and promote weight loss with either the POSE or Endomina system.
• Device Revisional gastroplasty
  Endoscopic suturing or plication of the stomach among patients who have previously undergone gastroplasty, sleeve gastrectomy, or Roux-en-Y gastric bypass to restrict the stomach and promote weight loss
• Device Transoral outlet reduction endoscopy (TORe)
  Reduction of the size of the gastro-jejunal anastomosis among patients who have previously undergone Roux-en-Y gastric bypass to promote weight loss. A variety of techniques may be used alone or in isolation including suturing (Apollo Overstitch), plication (POSE), argon photocoagulation, and endoscopic submucosal resection/dissection.
• Device Duodenal mucosal resurfacing (DMR)
  Endoscopic ablation of the post-ampullary duodenal mucosal to enhance improvement in glycaemic control among patients with type 2 diabetes.
• Device Intragastric balloon(s)
  The insertion of an intragastric implant into the stomach, which is subsequently filled with air or water to promote weight loss. Several intragastric balloons are available including Allurion, Heliosphere, Obalon, Orbera, and Spatz.

Primary outcome measures

• Total body weight loss percentage (TBWL%) [Time frame: 6-months, 1-, 2-, 3-, 5-years]
• Change in glycated haemoglobin (HbA1c; mmol/mol) [Time frame: 6-months, 1-, 2-, 3-, 5-years]
• Change in the number and dose of anti-diabetic medications [Time frame: 6-months, 1-, 2-, 3-, 5-years]

Secondary outcome measures (12)

• Procedure time (mins) [Time frame: Baseline]
• Inpatient stay (days) [Time frame: 6-months, 1-, 2-, 3-, 5-years]
• Adverse events [Time frame: 30-day, 6-months, 1-, 2-, 3-, 5-years]
• Change in systolic blood pressure measurements (mmHg) [Time frame: 6-months, 1-, 2-, 3-, 5-years]
• Change in diastolic blood pressure measurements (mmHg) [Time frame: 6-months, 1-, 2-, 3-, 5-years]
• Changes in number and dose of anti-hypertensive medications (n) [Time frame: 6-months, 1-, 2-, 3-, 5-years]
• Changes in low-density lipoprotein cholesterol (mmol/L) [Time frame: 6-months, 1-, 2-, 3-, 5-years]
• Changes in triglycerides (mmol/L) [Time frame: 6-months, 1-, 2-, 3-, 5-years]
• Changes in high-density lipoprotein cholesterol (mmol/L) [Time frame: 6-months, 1-, 2-, 3-, 5-years]
• Changes in total cholesterol (mmol/L) [Time frame: 6-months, 1-, 2-, 3-, 5-years]
• Changes in alanine transaminase (IU/L) [Time frame: 6-months, 1-, 2-, 3-, 5-years]
• Changes in aspartate aminotransferase (IU/L) [Time frame: 6-months, 1-, 2-, 3-, 5-years]

Eligibility criteria

Inclusion criteria

• Any patient undergoing a primary or revisional bariatric or metabolic endoscopic procedure.
• Age ≥ 18 years old
• Able to give written informed consent.

Exclusion criteria

• Any bariatric or metabolic endoscopic procedure performed outside the UK.
• Any bariatric or metabolic endoscopic procedure not currently listed within the registry protocol or agreed by the steering committee.
• Unable to provide written informed consent.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Observational model

Cohort

Study locations

United Kingdom · 1 center

• Cleveland Clinic London — London

Identifiers

NCT: NCT06305208 · CCLR-23-018

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗