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This study will evaluate the efficacy of capsule endoscopy (CE) versus ileocolonoscopy (IC) plus MRE for detection of active Crohn's disease (CD) in the small bowel in subjects with known CD and mucosal disease.
The primary objective of the study is to assess the accuracy of CE versus IC plus MRE for detecting active CD, by visualizing the small bowel and colon in subjects with known CD and mucosal disease.
There will be assessment of mucosal disease activity at baseline. Patient satisfaction questionnaire will be completed at baseline.
This is a multicenter, prospective, study, evaluating the efficacy of CE versus IC plus MRE for detecting active Crohn's Disease (CD) in the small bowel and colon in subjects with known CD and mucosal disease.
A screening visit will be performed within 30 days prior to baseline procedures to assess pre-procedure eligibility. At this visit the following assessments will be performed: Informed Consent, Inclusion/Exclusion Criteria, Demographics, Montreal Classification, Medical History, Previous GI procedures, Surgical history, Laboratory tests and pregnancy tests.
At baseline, subjects with known CD on routine evaluation (e.g. history, physical exams, labs) and a recent history of mucosal disease (within the last 2 years and diagnosis based on radiologic, endoscopic, or histologic findings) OR subjects with known CD and active disease based on clinical judgment based on symptoms, laboratory data or other clinical information will undergo Magnetic Resonance Enterography (MRE), Capsule Endoscopy (CE) and Ileocolonoscopy (IC), to assess presence or absence of CD across the small and large bowel. Also, at baseline the following assessments will take place: Laboratory tests, Pregnancy test, Concomitant medications, Patient satisfaction questionnaire and Adverse Events (AE).
Subjects will be exited from the study once all Baseline Procedures have been completed and AEs resolved.
All CE videos, IC videos and MRE images will be evaluated by central readers.
The planned number of subjects is 352. Subjects will be enrolled at up to 40 sites in the United States, Israel, and Austria. Study duration is expected to be up to approximately 1.5 years. The expected duration of each subject's participation is approximately 1 month.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| MRE, Patency Capsule (if needed), CE, and IC | Other | Single-arm study, which includes MRE procedure, Patency Capsule Procedure (if needed), PillCam Crohn's Capsule Endoscopy Procedure and Ileocolonoscopy procedure. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Capsule Endoscopy | Device | At baseline subject will under the PillCam Crohn's Capsule Procedure |
|
| Measure | Description | Time Frame |
|---|---|---|
| Accuracy of CE Versus IC Plus MRE for Detecting Active Crohn's Disease (CD), by Visualizing the Small Bowel and Colon in Subjects With Know CD and Mucosal Disease. | Central readers will be used to read all videos/images and analyses will be based on these results. A consensus panel will be used if there are discrepancies in results between modalities at baseline. Capsule endoscopy and IC results will be read by gastroenterologists and MRE results will be read by radiologists. Scores used will be Lewis Score, Simple Endoscopic Score for Crohn's Disease Index (SES-CD) Score and Magnetic Resonance Index of Activity (MaRIA) Score | Baseline |
| Measure | Description | Time Frame |
|---|---|---|
| Specificity, Negative Predictive Value, and Positive Predictive Value for Active CD in the Small Bowel and Colon by CE as Compared to IC Plus MRE. | Central readers will be used to read all videos/images and analyses will be based on these results. A consensus panel will be used if there are discrepancies in results between modalities at baseline. Capsule endoscopy and IC results will be read by gastroenterologists and MRE results will be read by radiologists. Scores used will be Lewis Score, Simple Endoscopic Score for Crohn's Disease Index (SES-CD) Score and Magnetic Resonance Index of Activity (MaRIA) Score |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| David Bruining, MD | Mayo | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of South Alabama | Mobile | Alabama | 36688 | United States | ||
| Mayo Clinic (Scottsdale, AZ) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 32499275 | Derived | Bruining DH, Oliva S, Fleisher MR, Fischer M, Fletcher JG; BLINK study group. Panenteric capsule endoscopy versus ileocolonoscopy plus magnetic resonance enterography in Crohn's disease: a multicentre, prospective study. BMJ Open Gastroenterol. 2020 Jun;7(1):e000365. doi: 10.1136/bmjgast-2019-000365. |
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Of the 187 subjects who signed informed consent, 29 failed inclusion/exclusion criteria and were exited from the study. Criteria included labs, which caused some subjects to wash out at this early phase. This left us with 158 subjects. For various reasons, 39 additional subjects were exited prior to all imaging procedures being completed.
187 subjects signed consent. Per the protocol, a subject was not considered "enrolled" until consent was signed and subject met inclusion/exclusion criteria. Of the 187 who signed consent, 158 were considered "enrolled" per the protocol. 29 were "screen failures", i.e. they signed informed consent, but ended up failing inclusion/exclusion.
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| ID | Title | Description |
|---|---|---|
| FG000 | MRE, Patency Capsule (if Needed), CE, and IC | Subjects will undergo MRE, patency capsule (if necessary), CE, and IC procedures. If MRE shows evidence of a stricture, subject must undergo a Patency procedure prior to CE. If patency not confirmed by MRE or patency capsule, subject is discontinued from study. Subjects will perform bowel preparation and follow a detailed dietary regimen for CE and IC procedures. Between 45 and 75 minutes after final polyethylene glycol (PEG) ingestion, subject will swallow the PillCam Crohn's Capsule. Adequate boosts will be administered, as necessary. Subjects will be allowed to leave clinic after 'Alert 2' is received and if capsule is not yet excreted. Subjects leaving prior to excretion will be instructed to disconnect the recorder at excretion or battery failure (whichever is first). After CE procedure (either same or following day), subject will undergo IC. If IC is done the following day, subject will stay on clear liquid diet (or NPO (nothing by mouth), per physician discretion). |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Nov 16, 2018 |
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| Baseline |
| Sensitivity, Specificity, Negative Predictive Value and Positive Predictive Value for Active CD in Designated Bowel Segments (Proximal Small Bowel Terminal Ileum, and Colon) by Capsule Endoscopy as Compared to IC Plus MRE | Central readers will be used to read all videos/images and analyses will be based on these results. A consensus panel will be used if there are discrepancies in results between modalities at baseline. Capsule endoscopy and IC results will be read by gastroenterologists and MRE results will be read by radiologists. Scores used will be Lewis Score, Simple Endoscopic Score for Crohn's Disease Index (SES-CD) Score and Magnetic Resonance Index of Activity (MaRIA) Score | Baseline |
| Patient Satisfaction | Patient preference of which procedure they preferred (CE, IC or MRE plus IC) | After completion of final procedure, either the same day or by the next business day following procedure completion. |
| Scottsdale |
| Arizona |
| 85259 |
| United States |
| Encore Borland Groover Clinical Research | Jacksonville | Florida | 32256 | United States |
| Children's Center for Digestive Healthcare | Atlanta | Georgia | 30342 | United States |
| Loyola University - Chicago | Maywood | Illinois | 60153 | United States |
| Indiana University | Indianapolis | Indiana | 46202 | United States |
| Indianapolis Gastroenterology Research Foundation | Indianapolis | Indiana | 46237 | United States |
| University of Kansas | Kansas City | Kansas | 66160 | United States |
| Louisiana State University Health Science Center | New Orleans | Louisiana | 70112 | United States |
| University of Massachusetts Memorial Medical Center | Worcester | Massachusetts | 01655 | United States |
| University of Michigan | Ann Arbor | Michigan | 48109 | United States |
| Mayo Clinic (Rochester, MN) | Rochester | Minnesota | 55905 | United States |
| Washington University | St Louis | Missouri | 63110 | United States |
| Atlantic Health (Morristown) | Morristown | New Jersey | 07962 | United States |
| Asheville Gastroenterology Associates, PA | Asheville | North Carolina | 28801 | United States |
| University Hospitals Cleveland Medical Center | Cleveland | Ohio | 44106 | United States |
| The Ohio State University Medical Center | Columbus | Ohio | 43210 | United States |
| Digestive Disease Specialists Inc. | Oklahoma City | Oklahoma | 73112 | United States |
| Hospital of the University of Pennsylvania | Philadelphia | Pennsylvania | 19104 | United States |
| Gastroenterology Associates of Tidewater | Chesapeake | Virginia | 23320 | United States |
| Carilion Clinic | Roanoke | Virginia | 24016 | United States |
| Virginia Gastroenterology Institute | Suffolk | Virginia | 23434 | United States |
| Virginia Mason Medical Center | Seattle | Washington | 98101 | United States |
| Medical College of Wisconsin | Milwaukee | Wisconsin | 53226 | United States |
| Allgemeines Krankenhaus - Universitatskliniken Wein | Vienna | 1090 | Austria |
| Sheba Medical Center | Tel Litwinsky | Ramat Gan | 5265601 | Israel |
| COMPLETED |
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| NOT COMPLETED |
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Per-protocol analysis set, included subjects who underwent MRE, CE, and IC (and could be evaluated for CD activity) with no major protocol deviations (violations that may have significant impact on outcomes) and did not meet the following: subject withdraw; capsule remained in stomach or small bowel for entire procedure; system technical failure
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| ID | Title | Description |
|---|---|---|
| BG000 | MRE, Patency Capsule (if Needed), CE, and IC | Subjects will undergo MRE, patency capsule (if necessary), CE, and IC procedures. If MRE shows evidence of a stricture, subject must undergo a Patency procedure prior to CE. If patency cannot be confirmed through MRE or patency capsule will be discontinued from the study. Subjects will perform bowel preparation and follow a detailed dietary regimen for CE and IC procedures. Between 45 and 75 minutes after final PEG ingestion, subject will swallow the PillCam Crohn's Capsule. Adequate boosts will be administered, as necessary. Subjects will be allowed to leave clinic after 'Alert 2' is received and if capsule is not yet excreted. Subjects leaving prior to excretion will be instructed to disconnect the recorder at excretion or battery failure (whichever is first). After CE procedure (either same or following day), subject will undergo IC. If the IC is done the following day, subject will stay on clear liquid diet (or NPO, per physician's discretion for sedation). |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants | Participants |
| ||||||||||||||||||
| Sex: Female, Male | Count of Participants | Participants |
| ||||||||||||||||||
| Race and Ethnicity Not Collected | Race and Ethnicity were not collected from any participant. | Count of Participants | Participants |
| |||||||||||||||||
| Region of Enrollment | Number | participants |
| ||||||||||||||||||
| BMI | Mean | Standard Deviation | kg/m² |
|
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Accuracy of CE Versus IC Plus MRE for Detecting Active Crohn's Disease (CD), by Visualizing the Small Bowel and Colon in Subjects With Know CD and Mucosal Disease. | Central readers will be used to read all videos/images and analyses will be based on these results. A consensus panel will be used if there are discrepancies in results between modalities at baseline. Capsule endoscopy and IC results will be read by gastroenterologists and MRE results will be read by radiologists. Scores used will be Lewis Score, Simple Endoscopic Score for Crohn's Disease Index (SES-CD) Score and Magnetic Resonance Index of Activity (MaRIA) Score | Per-protocol analysis set, includes subjects who underwent MRE, CE, and IC (and could be evaluated for CD activity) who had no major deviations (violations that may have significant impact on outcomes) and did not meet following criteria:
| Posted | Mean | 95% Confidence Interval | percentage of participants | Baseline |
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| Secondary | Specificity, Negative Predictive Value, and Positive Predictive Value for Active CD in the Small Bowel and Colon by CE as Compared to IC Plus MRE. | Central readers will be used to read all videos/images and analyses will be based on these results. A consensus panel will be used if there are discrepancies in results between modalities at baseline. Capsule endoscopy and IC results will be read by gastroenterologists and MRE results will be read by radiologists. Scores used will be Lewis Score, Simple Endoscopic Score for Crohn's Disease Index (SES-CD) Score and Magnetic Resonance Index of Activity (MaRIA) Score | Posted | Mean | 95% Confidence Interval | percentage of participants | Baseline |
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| Secondary | Sensitivity, Specificity, Negative Predictive Value and Positive Predictive Value for Active CD in Designated Bowel Segments (Proximal Small Bowel Terminal Ileum, and Colon) by Capsule Endoscopy as Compared to IC Plus MRE | Central readers will be used to read all videos/images and analyses will be based on these results. A consensus panel will be used if there are discrepancies in results between modalities at baseline. Capsule endoscopy and IC results will be read by gastroenterologists and MRE results will be read by radiologists. Scores used will be Lewis Score, Simple Endoscopic Score for Crohn's Disease Index (SES-CD) Score and Magnetic Resonance Index of Activity (MaRIA) Score | Posted | Mean | 95% Confidence Interval | percentage of participants | Baseline |
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| Secondary | Patient Satisfaction | Patient preference of which procedure they preferred (CE, IC or MRE plus IC) | Subjects who completed the satisfaction questionnaire and underwent all 3 procedures MRE, CE, and IC and could be evaluated for overall active CD at baseline (i.e., a modified intent-to-treat (mITT). population). | Posted | Count of Participants | Participants | After completion of final procedure, either the same day or by the next business day following procedure completion. |
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6 weeks plus 30 days - Events will be collected for all enrolled subjects with the start of baseline imaging procedures (MRE) and end 14 days following completion of the IC procedure. Subjects with Adverse Event (AE) 14 days following the IC procedure will be followed for 30 days or until event resolves, whichever comes first.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | MRE, Patency Capsule (if Needed), CE, and IC | Single-arm study, which includes MRE procedure, Patency Capsule Procedure (if needed), PillCam Crohn's Capsule Endoscopy Procedure and Ileocolonoscopy procedure. Capsule Endoscopy: At baseline subject will under the PillCam Crohn's Capsule Procedure | 0 | 119 | 7 | 119 | 11 | 119 |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Abdominal pain | Gastrointestinal disorders | ISO 14155:2011 | Non-systematic Assessment |
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| Crohn's Disease | Gastrointestinal disorders | ISO 14155:2011 | Non-systematic Assessment |
| |
| Complication of device removal | General disorders | ISO 14155:2011 | Non-systematic Assessment |
| |
| Clostridium difficile infection | Infections and infestations | ISO 14155:2011 | Non-systematic Assessment |
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| Serum sickness | Immune system disorders | ISO 14155:2011 | Non-systematic Assessment |
|
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Abdominal pain | Gastrointestinal disorders | ISO 14155:2011 | Non-systematic Assessment |
| |
| Constipation | Gastrointestinal disorders | ISO 14155:2011 | Non-systematic Assessment |
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| Haematochezia | Gastrointestinal disorders | ISO 14155:2011 | Non-systematic Assessment |
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| Haemorrhoids | Gastrointestinal disorders | ISO 14155:2011 | Non-systematic Assessment |
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| Infusion site extravasation | General disorders | ISO 14155:2011 | Non-systematic Assessment |
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| Oesophageal candidiasis | Infections and infestations | ISO 14155:2011 | Non-systematic Assessment |
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| Staphylococcal skin infection | Infections and infestations | ISO 14155:2011 | Non-systematic Assessment |
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| Infusion related reaction | Injury, poisoning and procedural complications | ISO 14155:2011 | Non-systematic Assessment |
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| Post procedural complication | Injury, poisoning and procedural complications | ISO 14155:2011 | Non-systematic Assessment |
| |
| Haemoglobin decreased | Investigations | ISO 14155:2011 | Non-systematic Assessment |
| |
| Arthralgia | Musculoskeletal and connective tissue disorders | ISO 14155:2011 | Non-systematic Assessment |
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| Myalgia | Musculoskeletal and connective tissue disorders | ISO 14155:2011 | Non-systematic Assessment |
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| Emotional distress | Psychiatric disorders | ISO 14155:2011 | Non-systematic Assessment |
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| Fatigue | General disorders | ISO 14155:2011 | Non-systematic Assessment |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Amanda Wenisch, Clinical Resaerch Coordinator / Study Manager | Medtronic GIH | 1-206-225-4025 | amanda.m.wenisch@medtronic.com |
| May 6, 2020 |
| Prot_SAP_000.pdf |
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| ID | Term |
|---|---|
| D003424 | Crohn Disease |
| D043183 | Irritable Bowel Syndrome |
| D015212 | Inflammatory Bowel Diseases |
| ID | Term |
|---|---|
| D005759 | Gastroenteritis |
| D005767 | Gastrointestinal Diseases |
| D004066 | Digestive System Diseases |
| D007410 | Intestinal Diseases |
| D003109 | Colonic Diseases, Functional |
| D003108 | Colonic Diseases |
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| ID | Term |
|---|---|
| D053704 | Capsule Endoscopy |
| ID | Term |
|---|---|
| D016099 | Endoscopy, Gastrointestinal |
| D016145 | Endoscopy, Digestive System |
| D004724 | Endoscopy |
| D003949 | Diagnostic Techniques, Surgical |
| D019937 | Diagnostic Techniques and Procedures |
| D003933 | Diagnosis |
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| >=65 years |
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| Israel |
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| Title | Measurements |
|---|---|
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| Specificity MRE + IC Overall |
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