Low-risk Colorectal Adenoma
Conditions
Brief summary
1. Complete a large-sample, multicenter, randomized blank-controlled clinical trial to evaluate Shenling Baizhu Granules for the prevention of colorectal adenoma recurrence. 2. Generate high-level, internationally recognized clinical evidence to support the development of clinical practice guidelines for the prevention and treatment of colorectal adenoma using traditional Chinese medicine, and to strengthen the recommendation level of Shenling Baizhu Granules in clinical guidelines. 3. Define the clinical characteristics of patient subgroups most likely to benefit from Shenling Baizhu Granules for preventing colorectal adenoma recurrence.
Detailed description
This study is designed within the traditional Chinese medicine (TCM) framework for colorectal adenoma and will be conducted as a prospective, multicenter, open-label, randomized, blank-controlled clinical trial. All participants will undergo standard endoscopic minimally invasive treatment and receive health education. In addition to these measures, participants in the intervention group will receive Shenling Baizhu Granules (6 g per dose, three times daily). The intervention will be initiated within 3 months after the baseline treatment/health education and continued for 6 consecutive months. Participants in the control group will not receive Shenling Baizhu Granules. At baseline, demographic characteristics, adenoma-related information, and TCM syndrome assessment scores will be collected. Follow-up will be conducted every 6 months during the first 2 years, and once in the third year. Biospecimens and TCM assessments will be collected at three time points: (i) baseline, (ii) 6 months after initiation of medication in Year 1, and (iii) after colonoscopic reassessment in Year 3. At each time point, plasma, stool, tongue coating, saliva, and tissue samples, as well as the TCM syndrome assessment questionnaire, will be obtained. To characterize the subpopulation most likely to benefit from Shenling Baizhu Granules in preventing colorectal adenoma recurrence, we will integrate and analyze: baseline clinical factors (e.g., age, sex, family history of cancer, smoking and alcohol use); conventional medical features (e.g., adenoma location, number, size, histopathological type, and concomitant medications); TCM-related features (e.g., evolution of TCM syndrome patterns and objective tongue/pulse parameters); and biological profiles (e.g., cytokines, proteins, metabolites, and gut microbiota). Common characteristics of the beneficial population will then be summarized based on these multidimensional data.
Interventions
DRUGShenling Baizhu granules (TCM patent medicine)
Shenling Baizhu granules is a traditional Chinese medicine preparation in granular form. Participants in the experimental group will take 6 g orally three times daily for 6 months, initiated within 3 months after baseline endoscopic resection and health education. The granules should be taken before meals or at the same time as eating. The granules contain multiple Chinese herbs including Ginseng, Poria, Atractylodes macrocephala, and other traditional ingredients. This formulation is standardized according to Chinese pharmacopoeia standards and is manufactured under GMP conditions. This intervention is being tested for its ability to prevent the recurrence of low-risk colorectal adenomas after endoscopic resection.
Sponsors
Shanghai Jiao Tong University School of Medicine
Affiliated Hospital of Nanjing University of Chinese Medicine
Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
Sixth Affiliated Hospital, Sun Yat-sen University
Shuguang Hospital of Shanghai University of Traditional Chinese Medicine
Beijing Friendship Hospital
Yueyang Hospital of Integrated Traditional Chinese and Western Medicine
Institute of Science, Beijing Tongrentang Co., Ltd.
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
* Meets the diagnostic criteria for low-risk colorectal adenoma. * Has undergone a colonoscopy of adequate quality (adequate bowel preparation, cecal intubation achieved, and withdrawal time ≥6 minutes) and received endoscopic minimally invasive polypectomy. * Within 3 months after adenoma resection. * 18-70 years of age; any sex. * Willing to participate and has voluntarily provided written informed consent.
Exclusion criteria
* Incomplete adenoma resection. * Long-term use of aspirin, folic acid, calcium supplements, vitamin D, or similar agents. * Known hereditary polyposis syndromes (e.g., familial adenomatous polyposis) or hereditary colorectal cancer syndromes (e.g., Lynch syndrome/hereditary nonpolyposis colorectal cancer). * Colonoscopy findings strongly suggestive of inflammatory bowel disease. * History of malignancy within the past 5 years. * Pregnant or breastfeeding women, or participants with pregnancy potential who are planning pregnancy. * Severe cardiovascular or cerebrovascular disease, hepatic or renal insufficiency, or diabetes mellitus. * Severe psychiatric disorders that would preclude cooperation with colonoscopy procedures. * Current condition preventing oral administration of the study drug (e.g., dysphagia, chronic diarrhea, intestinal obstruction). * Participation in another clinical study within the past 3 months or current participation in another clinical study. * Any other condition that, in the investigator's judgment, makes the participant unsuitable for enrollment.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of metachronous low-risk adenomas within 3 years after first dose | At 3 years after enrollment | The incidence of metachronous low-risk adenomas will be calculated for each group as the number of participants with metachronous low-risk adenomas detected on surveillance colonoscopy within 3 years of enrollment divided by the total number of participants in that group. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Colorectal adenoma progression rate | At 3 years after enrollment | The progression rate will be calculated for each group as the number of participants in whom colorectal adenoma progression (defined as high-risk adenoma and/or malignant transformation) is detected on surveillance colonoscopy within 3 years after enrollment divided by the total number of participants in that group. |
| TCM syndrome score | At baseline, 6 months, and 36 months | The Traditional Chinese Medicine Syndrome Survey assesses bowel habits, abdominal symptoms, and secondary symptoms like oral discomfort and appetite, with scores ranging from 0 (no symptoms) to higher values indicating increasing severity, alongside tongue and pulse observations. |
Countries
China
Contacts
CONTACTXiaobo Li
Outcome results
None listed