Fistula, Regenerative Medicine, Stromal Vascular Fraction
Conditions
Keywords
Gastrointestinal fistula, Stromal vascular fraction, Endoscopic fistula closure, Regenerative endoscopy, Mesenchymal stromal cells
Brief summary
RESTOREGI Study Benign gastrointestinal fistulas are abnormal communications between the gastrointestinal tract and adjacent organs or the skin. Chronic fistulas are often difficult to treat because of persistent inflammation, fibrosis, impaired vascularity, and defective tissue regeneration. Endoscopic regenerative therapy using mechanically processed autologous total stromal vascular fraction-enriched microfragmented adipose tissue (tSVF-EM) has emerged as a novel therapeutic approach that may promote tissue repair through angiogenesis, immunomodulation, and regenerative signaling. Although early clinical experience suggests promising healing outcomes, factors predicting successful fistula closure remain poorly understood. The RESTOREGI study is a prospective, single-center observational cohort study designed to identify patient-related, fistula-related, and procedural factors associated with successful healing following endoscopic tSVF-EM therapy in benign gastrointestinal fistulas. The study will also evaluate treatment safety, time to healing, recurrence rates, and the impact of procedural variables on outcomes.
Detailed description
Benign gastrointestinal fistulas are abnormal communications between the gastrointestinal tract and adjacent organs or the skin that can result in significant morbidity, prolonged hospitalization, impaired quality of life, and repeated therapeutic interventions. Chronic fistulas are characterized by persistent inflammation, fibrosis, impaired perfusion, and defective tissue regeneration, all of which may contribute to failure of conventional closure techniques and recurrent disease. Endoscopic regenerative therapy using autologous total stromal vascular fraction-enriched microfragmented adipose tissue (tSVF-EM) has emerged as a novel therapeutic approach for the management of complex gastrointestinal defects. Following adipose tissue harvest and mechanical processing, tSVF-EM contains a heterogeneous population of stromal and regenerative cells, extracellular matrix components, and bioactive factors that may promote angiogenesis, immunomodulation, tissue remodeling, and wound healing. Endoscopic delivery of this material directly into the fistula margins aims to create a biologically favorable environment for durable tissue repair. Early clinical experience with regenerative endoscopic therapies has demonstrated technical feasibility and encouraging healing outcomes in selected patients with benign gastrointestinal fistulas. However, considerable variability in treatment response exists, and factors associated with successful healing remain poorly understood. Improved understanding of patient-related, fistula-related, and procedural determinants of treatment success may facilitate better patient selection, optimize procedural planning, guide the use of adjunctive therapies, and improve overall clinical outcomes. The RESTOREGI study is a prospective, single-center, real-world cohort study designed to evaluate clinical outcomes following endoscopic tSVF-EM therapy in patients with benign gastrointestinal fistulas. Standardised data will be collected regarding patient characteristics, fistula anatomy and etiology, inflammatory and nutritional status, and procedural factors associated with regenerative endotherapy. The study is intended as an exploratory, hypothesis-generating investigation to identify clinically meaningful factors associated with fistula healing and to establish prospective safety and effectiveness data in this emerging field of regenerative endoscopy. Findings from this study are expected to provide foundational evidence for future multicenter studies and contribute to the development of evidence-based patient selection and treatment strategies for regenerative management of benign gastrointestinal fistulas.
Interventions
PROCEDUREEndoscopic tSVF-EM Therapy
Autologous adipose tissue will be harvested using standard liposuction techniques and mechanically processed to obtain total stromal vascular fraction-enriched microfragmented adipose tissue (tSVF-EM). The processed tissue will be injected endoscopically into the margins and/or tract of benign gastrointestinal fistulas according to institutional regenerative endoscopy protocols. Adjunctive endoscopic therapies, including argon plasma coagulation (APC), fistula tract abrasion or curettage, clips, over-the-scope clips (OTSC), endoscopic suturing, or stent placement, may be performed at the discretion of the treating physician. Repeat tSVF-EM treatment sessions may be undertaken based on clinical response and persistence of the fistula.
Sponsors
Asian Institute of Gastroenterology, India
Study design
Allocation
NA
Intervention model
SEQUENTIAL
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age ≥18 years * Confirmed benign gastrointestinal fistula involving the luminal gastrointestinal tract * Fistula accessible for endoscopic evaluation and treatment * Planned treatment with endoscopic tSVF-EM therapy, with or without adjunctive endoscopic therapies (argon plasma coagulation \[APC\], tract abrasion/curettage, clips, over-the-scope clips \[OTSC\], endoscopic suturing, or stent placement) * Ability and willingness to provide written informed consent * Willingness to comply with scheduled follow-up visits and study assessments
Exclusion criteria
* Perianal fistulas of any aetiology * Inflammatory bowel disease-associated fistulas, including fistulas related to Crohn's disease or ulcerative colitis * Malignancy-related fistulas * Fistulas requiring primary oncologic surgical management * Uncontrolled sepsis or undrained abscess at baseline (patients may become eligible following adequate drainage and clinical stabilisation) * Contraindication to adipose tissue harvest, sedation, anaesthesia, or therapeutic endoscopy * Pregnancy or lactation * Severe coagulopathy not correctable prior to intervention * Inability to provide informed consent * Anticipated inability to complete study follow-up * Participation in another interventional study that may influence fistula healing outcomes
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Composite Fistula Healing at 6 Months | 6 months following the first tSVF-EM treatment session | Composite fistula healing is defined as the simultaneous achievement of: Clinical resolution of the fistula, characterized by the absence of fistula output, drainage, or symptoms attributable to the fistula; and Objective confirmation of closure demonstrated by either: Endoscopic evidence of complete closure of the fistula opening, or Radiological evidence of absence of contrast extravasation or fistulous communication on appropriate imaging studies. Participants meeting both criteria will be classified as having achieved successful fistula healing. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of tSVF-EM Treatment Sessions Required for Healing | Up to 12 months after first treatment session | Total number of endoscopic tSVF-EM treatment sessions required to achieve composite fistula healing. |
| Time to Fistula Healing | Up to 12 months after first treatment session | Time from the first tSVF-EM treatment session to achievement of composite fistula healing, defined as clinical resolution of fistula output and objective confirmation of closure by endoscopy or imaging. |
| Fistula Recurrence Rate | 12 months after first treatment session | Proportion of participants who develop recurrence of a previously healed fistula, defined as reappearance of clinical drainage and/or objective evidence of fistula reopening after documented healing. |
| Treatment-Related Adverse Events | From treatment initiation through 12 months of follow-up | Incidence, type, severity, and outcome of adverse events related to adipose tissue harvest, endoscopic intervention, sedation/anesthesia, and delayed infectious complications. Adverse events will be graded according to the ASGE Lexicon classification system. |
| Overall Clinical Healing Rate | 12 months after first treatment session | Proportion of treated fistulas achieving clinical healing during the study period. |
| Need for Additional Endoscopic or Surgical Intervention | 12 months after first treatment session | Proportion of participants requiring alternative endoscopic therapies, radiologic interventions, or surgery because of persistent or recurrent fistula despite tSVF-EM therapy. |
Countries
India
Contacts
CONTACTGoutham K Katukuri, MBBS, MD, DM
CONTACTRajendra Patel, MBBS, MD, DM
PRINCIPAL_INVESTIGATORGoutham R Katukuri, MBBS, MD, DM
AIG Hospitals
Outcome results
None listed