Transanal Irrigation - Best Treatment Possibility for Low Anterior Resection Syndrome? Multicenter, Randomized Clinical Trial
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ClinicalTrials.gov Identifier: NCT05920681 |
Recruitment Status :
Recruiting
First Posted : June 27, 2023
Last Update Posted : November 8, 2023
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Introduction: About 50% of patients who undergo rectal resection (mostly as a treatment for rectal cancer) suffer from various and partly severe functional problems, despite the preservation of the anal fold. These complaints are summarized as low anterior resection syndrome (LARS). So far, there are no randomized clinical trials that would definitively confirm or deny the hypothesis regarding the most effective treatment for LARS.
Objectives: To evaluate whether transanal irrigation improves bowel function and quality of life in patients after rectal resection compared with the best supportive care.
Methods and analysis: Patients who have undergone low anterior resection will be approached for this study. During the patient's visit, we will assess their complaints regarding defecation problems, as well as any deterioration in their overall quality of life. To gather this information, we will have the patients fill out questionnaires such as the LARS (Low Anterior Resection Syndrome) and Wexner scale, along with quality of life questionnaires. Questionnaires and scales will be filled out again during the visit every 3 months for 1 year.
Discussion: This multicentre, randomized controlled trial will lead to a better understanding of LARS treatment. Moreover, it will be hypothesis generating and inform areas needing future prospective studies.
Condition or disease | Intervention/treatment | Phase |
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Low Anterior Resection Syndrome | Procedure: Transanal irrigation Combination Product: Best supportive care | Not Applicable |
Study Type : | Interventional (Clinical Trial) |
Estimated Enrollment : | 40 participants |
Allocation: | Randomized |
Intervention Model: | Parallel Assignment |
Intervention Model Description: | Individuals participating in this study will be randomly divided into groups 1 and 2 by randomization. The probability of falling into one or the other group is equal.
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Masking: | Double (Participant, Care Provider) |
Masking Description: | During the research, the name and surname of the subject will be replaced by a special code, according to which it will not be possible to determine the identity of the subject. The subject will be randomly assigned a combination of numbers and/or letters, which will not use the patient's name, surname, initials or other personally identifiable information. This code will be used in all study documents except the consent form. If the law does not provide otherwise, only the doctor conducting the study, the research staff will be able to get acquainted with the confidential data revealing the name and surname. |
Primary Purpose: | Supportive Care |
Official Title: | Transanal Irrigation - Best Treatment Possibility for Low Anterior Resection Syndrome? Multicenter, Randomized Clinical Trial |
Actual Study Start Date : | June 18, 2023 |
Estimated Primary Completion Date : | May 1, 2025 |
Estimated Study Completion Date : | May 1, 2025 |
Arm | Intervention/treatment |
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Experimental: Transanal irrigation group
Transanal irrigation will be applied to patients who will enter the experimental group. The patient lies on the left or right side, depending on the main hand, the knees are bent. With the main hand, he carefully introduces the TAI tip lubricated with lubricant. The TAI bag is filled with warm water - it can be boiled or just from the tap. The contents of the TAI bag are slowly administered through the anus. The duration of the TAI is about 15-20 minutes. Afterwards, the subject goes to defecate until the bowel is empty. This action should be repeated daily.
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Procedure: Transanal irrigation
The patient lies on the left or right side, depending on the main hand, the knees are bent. With the main hand, he carefully introduces the TAI tip lubricated with lubricant. The TAI bag is filled with warm water - d it can be boiled or just from the tap. The contents of the TAI bag are slowly administered through the anus. The duration of the TAI is about 15-20 minutes. Afterwards, the subject goes to defecate until the bowel is empty. This action should be repeated daily. |
Active Comparator: Best supportive care group
The control group will receive best supportive care (diet modification, Loperamidum if needed, diapers, etc). Loperamidum Dosage form: Loperamide Tablets (2mg of loperamide hydrochloride.). Dosage: Initial dose - 2 tablets immediately, then - 1 tablet after each loose stool, but not earlier than 2-3 hours after the initial dose. Do not exceed the maximum daily dose - no more than 6 tablets for adults (maximum daily dose 12 mg). |
Combination Product: Best supportive care
Diet modification, Loperamidum if needed, diapers, etc. |
- Proportion of patients for whom transanal irrigation reduced LARS symptom scores [ Time Frame: 1 year ]Assess the proportion of patients with transanal irrigation that reduces the symptoms of LARS.
- Proportion of patients for whom best supportive treatment reduced LARS symptom scores [ Time Frame: 1 year ]Assess the proportion of patients with best supportive care that reduces the symptoms of LARS.
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Ages Eligible for Study: | 18 Years and older (Adult, Older Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Subject is an adult (≥ 18 years);
- Agrees to participate in a study;
- A low anterior resection (robotic, laparoscopic or open) was performed (anastomosis up to 5-7 cm from the anocutaneous line when assessed with a finger or endo(recto)scope);
- >12 months have passed since the operation or the closure of the ileostomy (if formed);
- No anastomotic leak or stenosis (assessed clinically, during examination, and/or proctogram);
- LARS >30 points (major LARS).
Exclusion Criteria:
- Tumor recurrence/progression
- Pregnancy
- Diagnosed with inflammatory bowel disease (ICD codes K50-59).
- Side-to-end anastomosis
- Palliative care
- Will not be able to perform irrigation
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT05920681
Contact: Audrius Dulskas, PhD | (85) 219 0947 | audrius.dulskas@nvi.lt |
Lithuania | |
National Cancer Institute | Recruiting |
Vilnius, Lithuania, 14186 | |
Contact: Audrius Dulskas +37067520094 audrius.dulskas@gmail.com |
Responsible Party: | Audrius Dulskas, Surgeon (oncologist), National Cancer Institute, Lithuania |
ClinicalTrials.gov Identifier: | NCT05920681 |
Other Study ID Numbers: |
LARSTAI |
First Posted: | June 27, 2023 Key Record Dates |
Last Update Posted: | November 8, 2023 |
Last Verified: | November 2023 |
Studies a U.S. FDA-regulated Drug Product: | No |
Studies a U.S. FDA-regulated Device Product: | No |
Low Anterior Resection Syndrome Transanal irrigation Fecal Incontinence |
Colorectal Surgery Quality of Life Randomized Controlled Trial |
Low Anterior Resection Syndrome Syndrome Disease Pathologic Processes Colonic Diseases |
Intestinal Diseases Gastrointestinal Diseases Digestive System Diseases Rectal Diseases Postoperative Complications |