Purpose

The purpose of this investigation is to demonstrate the safety and effectiveness of Lower Esophageal Sphincter (LES) Stimulation System in treating gastroesophageal reflux disease (GERD). This investigation is a multicenter, randomized, double-blind, sham-controlled study. After the implant procedure, subjects will be randomized to either the Treatment Group (immediate stimulation) or Control Group (delayed stimulation) for six months followed by an additional open-label phase in which all subjects will receive electrical stimulation. Subjects continue on stimulation treatment in an extended open-label follow-up phase through 5 years post-stimulation.

Conditions

Eligibility

Eligible Ages
Between 22 Years and 75 Years
Eligible Genders
All
Accepts Healthy Volunteers
No

Inclusion Criteria

  1. Able and willing to provide written informed consent 2. Able and willing to comply with required study procedures and follow-up schedule 3. 22 - 75 years of age at the time of informed consent 4. Documented symptoms of gastroesophageal reflux disease (GERD) for longer than 6 months (regurgitation and/or heartburn which is defined as burning epigastric or substernal pain which responds to acid neutralization or suppression) which requires daily use of proton pump inhibitors (PPIs) or other anti-reflux drug therapy, who continue to have symptoms despite maximum medical therapy or are "intolerant" -severe side-effects (e.g. anaphylaxis or severe allergic reaction, recurrent C. difficile, severe hypomagnesaemia) to one PPI or mild/moderate side effect (e.g. nausea, vomiting, diarrhea or abdominal pain) to at least 2 PPIs of different chemical classes. 5. Symptomatic improvement on PPI therapy demonstrated by a composite GERD-health-related quality of life (HRQL) score of ≥20 off PPI, and a ≥10 point improvement on PPI compared to the off PPI composite GERD-HRQL score. Patients who meet the definition above of PPI intolerant are not required to have ≥10 point improvement. The on-PPI score to satisfy this criterion will be the score from the GERD-HRQL assessment completed after resuming PPIs following the Baseline visit. 6. Excessive lower esophageal acid exposure during pH monitoring (defined as distal esophageal pH < 4 for > 6.0% of the monitoring time) performed after at least 5 days off of PPIs and at least 2 days off of H2 blockers. At least 18 hour of esophageal pH recording will be considered adequate and inclusion will be based on the day (at least 18 hours of valid data) with the highest acid exposure percentage time. 7. Esophagitis ≤ Grade B (Los Angeles (LA) classification) as measured by upper endoscopy off PPI and H2 blockers for 10-14 days 8. Esophageal body contraction amplitude > 30 mmHg for > 30% of swallows and > 30% peristaltic contractions on HRM or ≥ 30% peristaltic contractions with DCI >450. 9. Suitable surgical candidate able to undergo general anesthesia and laparoscopic surgery

Exclusion Criteria

  1. Previous EndoStim LES System implant and/or implant attempt 2. Previous surgery involving the gastroesophageal junction or the lead implant site, such as a Nissen fundoplication 3. Previous endoscopic intervention for the treatment of GERD and/or Barrett's esophagus 4. Hiatal hernia larger than 3 cm as determined by endoscopy 5. History of gastroparesis 6. Any non-GERD esophageal motility disorders that in the opinion of investigator precludes an anti-reflux procedure 7. History of or known esophageal stricture or significant esophageal anatomic abnormalities (obstructive lesions, etc.) 8. Barrett's esophagus or any grade of dysplasia 9. Documented history of esophagitis Grade C or D (LA Classification) 10. History of suspected or confirmed esophageal or gastric cancer 11. Esophageal or gastric varices 12. Symptoms of dysphagia more than once per week every week within the last 3 months 13. Unable to tolerate withdrawal from H2 Blockers or PPI medications 14. Suspected or known allergies to titanium, platinum, iridium, stainless steel, silicone, epoxy, or nylon 15. Body mass index (BMI) > 35 kg/m2 16. Any significant multisystem diseases 17. Autoimmune or a connective tissue disorder (scleroderma, dermatomyositis, Calcinosis-Raynaud's-Esophagus Sclerodactyly Syndrome (CREST), Sjogren's Syndrome, Sharp's Syndrome, etc.) requiring therapy in the preceding 2 years 18. Type 1 diabetes mellitus or uncontrolled Type 2 diabetes mellitus (T2DM) defined as HbA1c > 9.5 in the previous 6 months or at screening/baseline 19. Significant cardiac arrhythmia or ectopy or significant cardiovascular disease (i.e. unstable angina pectoris, hemodynamically significant valvular disease, severe congestive heart failure), or any cardiac therapeutic intervention within the last 6 months. 20. Significant cerebrovascular event within the last 6 months 21. Existing implanted electrical stimulator (pacemaker, implantable cardioverter defibrillator, deep brain stimulator (DBS), bone growth or pelvic floor stimulators, drug pumps, etc.) 22. Female subject of child-bearing potential and is pregnant or nursing, or intends to become pregnant during the trial period, who is not using a reliable form of birth control 23. Currently enrolled in other potentially confounding research 24. Active infection as determined by the investigator 25. History of any malignancy, other than basal cell carcinoma, in the last 2 years 26. Life expectancy less than 3 years aa. Diagnosed major psychiatric disorder (bipolar, schizophrenia, etc.) bb. Any condition that, at the discretion of the investigator or sponsor, would interfere with accurate interpretation of the study endpoints or preclude participation in the trial

Study Design

Phase
N/A
Study Type
Interventional
Allocation
Randomized
Intervention Model
Crossover Assignment
Primary Purpose
Treatment
Masking
Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)

Arm Groups

ArmDescriptionAssigned Intervention
Sham Comparator
Control Group
This group will undergo laparoscopic implantation surgery. The device will not be activated: Sham EndoStim stimulation for first six months of study. It will be activated at the Month 6 visit and provide lower esophageal stimulation from Month 6 thru end of study.
  • Procedure: Laparoscopic implantation surgery
    Laparoscopic surgery to implant the pulse generator and bipolar lead.
  • Device: EndoStim stimulation from Month 6 thru end of study
    Lower esophageal stimulation
    Other names:
    • EndoStim Implantable Pulse Generator (IPG)
    • lower esophageal stimulation
  • Device: Sham EndoStim stimulation for first six months of study
    EndoStim device remains "off" (no stimulation delivered)
Experimental
Treatment Group
The group will undergo laparoscopic implantation surgery. The device will be activated two weeks post-implantation and the subject will receive EndoStim stimulation for first six months of study and continue with EndoStim stimulation from Month 6 thru end of study.
  • Procedure: Laparoscopic implantation surgery
    Laparoscopic surgery to implant the pulse generator and bipolar lead.
  • Device: EndoStim stimulation for first six months of study
    Lower esophageal stimulation
    Other names:
    • EndoStim Implantable Pulse Generator (IPG)
    • lower esophageal stimulation
  • Device: EndoStim stimulation from Month 6 thru end of study
    Lower esophageal stimulation
    Other names:
    • EndoStim Implantable Pulse Generator (IPG)
    • lower esophageal stimulation

More Details

Status
Terminated
Sponsor
EndoStim Inc.

Study Contact

Detailed Description

The purpose of this investigation is to demonstrate the safety and effectiveness of the EndoStim® Lower Esophageal Sphincter (LES) Stimulation System in the treatment of subjects with gastroesophageal reflux disease (GERD). This investigation is a multicenter, randomized, double-blind, sham-controlled clinical investigation. After the implant procedure, subjects will be randomized to either the Treatment Group (immediate stimulation) or Control Group (delayed stimulation) for a 6-month, double-blind phase followed by an additional open-label treatment phase in which all subjects will receive electrical stimulation therapy for a total of 12 months. Subjects continue on stimulation treatment and an extended open-label follow-up phase includes an 18 month post-stimulation phone interview followed by annual visits through 5 years post-stimulation.

Notice

Study information shown on this site is derived from ClinicalTrials.gov (a public registry operated by the National Institutes of Health). The listing of studies provided is not certain to be all studies for which you might be eligible. Furthermore, study eligibility requirements can be difficult to understand and may change over time, so it is wise to speak with your medical care provider and individual research study teams when making decisions related to participation.