Evaluating Clinical Effects of a Spray-Type Bio-absorbable Adhesion Barrier System in Paediatric Patients (PEARL)
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| ClinicalTrials.gov Identifier: NCT05255081 |
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Recruitment Status :
Recruiting
First Posted : February 24, 2022
Last Update Posted : May 11, 2023
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| Condition or disease | Intervention/treatment | Phase |
|---|---|---|
| Surgical Adhesions | Device: Adspray Procedure: Placebo-control | Not Applicable |
Postoperative adhesions are fibrovascular bands connecting the parietal peritoneum to the visceral peritoneum of intra-abdominal organs, or connecting intra-abdominal organs to one another, which developed unavoidably following virtually all body cavity surgeries. Adhesions affect up to 80-93% of patients following abdominal surgery. Being the leading cause of postoperative small bowel obstruction, it could potentially cause other enormous clinical problems including difficulty in subsequent operations, infertility, and chronic pain. The incidence of adhesion-related morbidity is estimated to be 2.2% to 19.5% in the pediatric population, among which large proportion of patients required subsequent surgical intervention. A variety of techniques and products (e.g. bioresorbable physical barrier agents, pharmacological adjuncts, etc) have been advocated for preventing postoperative adhesion formation. However, to date, no single treatment is proven to be effective and adhesions still remain a significant, unresolved postoperative complication both in adults and paediatric populations.
To reduce postoperative adhesions, Terumo Corporation (Tokyo, Japan) has developed an adhesion barrier system (AdSpray™; Terumo Corporation, Tokyo, Japan) which is easy to use at the treatment site in various surgical procedures. Its ability of adhesion prevention had been demonstrated in porcine model study. Cezar et al and Suto et al subsequently published two human prospective randomized controlled trials on the use of this barrier system in adult patients undergoing gynaecological and gastrointestinal operations, which confirmed its safety and efficacy. However, to date, studies on the use of anti-adhesion agents in children are scarce and there is no study on this novel barrier system (AdSpray™) in children. In view of this, we plan to conduct a prospective randomized single-blind study where a placebo group served the control, to confirm the efficacy and safety of AdSpray™ as an inhibitory effect of postoperative adhesion formation in paediatric patients who underwent laparotomy with stoma.
B. Study objective To investigate the effect of a novel spray-type, novel dextrin hydrogel adhesion barrier (AdSpray™; Terumo Corporation, Tokyo, Japan) on postsurgical adhesions.
C. Study design and methods This is a prospective, single center, single-blinded randomized controlled trial using a parallel arm design and placebo group as the control. Patient enrollment will start in March 2022 and expected to end in 2023.
| Study Type : | Interventional (Clinical Trial) |
| Estimated Enrollment : | 20 participants |
| Allocation: | Randomized |
| Intervention Model: | Parallel Assignment |
| Intervention Model Description: | Eligible subjects will be identified, and parents will be approached for patient recruitment. Once consent to participation is signed, the patients will be randomised into either treatment group (AdSpray™) or placebo-controlled group in 1:1 ratio using simple randomization. The adhesion-assessment team will be blinded to the group allocated. The spray will be prepared according to the group allocated by a dedicated scrub nurse. For treatment group, AdSpray™ will be instilled into the drug chamber; for placebo group, saline will be instilled instead. |
| Masking: | Double (Participant, Outcomes Assessor) |
| Masking Description: | After completion of necessary operative procedures in the primary operation, barrier agent (AdSpray™or Placebo) will be sprayed to fully cover the organs under the laparotomy incision. At the second-look surgery, laparoscopic video recordings of the area under the laparotomy incision will be made in both groups. For the efficacy evaluation, based on the laparoscopic images of the abdominal cavity at the time of the second-look surgery, the presence, extent, and severity of adhesions will be assessed by the adhesion-assessment team which is independent of the study. The independent adhesion-assessment team will assess the extent and severity of adhesions under the laparotomy incision on a 4-grade scale. |
| Primary Purpose: | Prevention |
| Official Title: | A Prospective Single-blind Randomised Controlled Trial Evaluating Clinical Effects of a Novel Spray-Type Bio-absorbable Adhesion Barrier System (AdSpray™) in Paediatric Patients Requiring Laparotomy |
| Actual Study Start Date : | March 1, 2022 |
| Estimated Primary Completion Date : | March 1, 2024 |
| Estimated Study Completion Date : | December 31, 2024 |
| Arm | Intervention/treatment |
|---|---|
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Experimental: Treatment Arm
Application of AdSpray™ over all organs under the laparotomy incision at the end of operation
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Device: Adspray
Application of AdSpray™ over all organs under the laparotomy incision at the end of operation |
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Placebo Comparator: Control Arm
Spray with saline would be applied to organs under incision
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Procedure: Placebo-control
Spray with saline would be applied to organs under incision |
- Incidence of adhesion [ Time Frame: 6 months ]The number of participants developed adhesion during the study period at the second operation assessment
- Extent of adhesion [ Time Frame: 6 months ]Extent of adhesion is classified into 4 grade: Grade 0 - none, Grade 1 - adhesion less than 1/3 the length of incision, Grade 2 - adhesions between 1/3 and <2/3 the length of the incision, Grade 3 - Adhesion great or equal than 2/3 the length of the incision
- Severity of adhesion [ Time Frame: 6 months ]Severity of adhesion is classified into 4 grade: Grade 0 - none, Grade 1 - film-like with no neovascularisation, Grade 2 - moderately thick with partial neovascularisation, Grade 3 - thick, solid adhesion with neovascularisation
- Adverse events [ Time Frame: 6 months ]Intestinal obstruction, abscess, peritonitis, surgical wound infection, malfunction of device, etc.
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| Ages Eligible for Study: | up to 18 Years (Child, Adult) |
| Sexes Eligible for Study: | All |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Patients requiring laparotomy and staged operation with closure of stoma as second operation e.g. Necrotising Enterocolitis, Anorectal malformation, Hirschsprung's disease, etc.
Exclusion Criteria:
- A history of hypersensitivity to substances derived from corn starch
- A history of surgery in the abdominal cavity or pelvic cavity accompanied by a laparotomy scar
- Patients with peritonitis
- Laparoscopic assessment of adhesions may not be performed safely at the second-look surgery.
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): NCT05255081
| Contact: Adrian Chi Heng Fung, MBBS | 85268994430 | fungchiheng@gmail.com |
| Hong Kong | |
| Department of Surgery, University of Hong Kong | Recruiting |
| Hong Kong, Hong Kong, 0000 | |
| Contact: Adrian Fung, MBBS +85222554850 fungchiheng@gmail.com | |
| Principal Investigator: | Adrian Chi Heng Fung, MBBS | The University of Hong Kong |
| Responsible Party: | The University of Hong Kong |
| ClinicalTrials.gov Identifier: | NCT05255081 |
| Other Study ID Numbers: |
PEARLTrial |
| First Posted: | February 24, 2022 Key Record Dates |
| Last Update Posted: | May 11, 2023 |
| Last Verified: | May 2023 |
| Individual Participant Data (IPD) Sharing Statement: | |
| Plan to Share IPD: | No |
| Studies a U.S. FDA-regulated Drug Product: | No |
| Studies a U.S. FDA-regulated Device Product: | No |
| Product Manufactured in and Exported from the U.S.: | No |
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