Fetal Endoscopic Tracheal Occlusion for Congenital Diaphragmatic Hernia

(FETO Trial)

Recruiting in Palo Alto (17 mi)

Overseen by Yair Blumenfeld

Age: 18 - 65

Sex: Female

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Recruiting

Sponsor: Yair Blumenfeld

Disqualifiers: Hypertension, Diabetes, Obesity, others

No Placebo Group

Approved in 2 Jurisdictions

Trial Summary

What is the purpose of this trial?

This trial is testing a procedure where a small balloon is placed in an unborn baby's windpipe to help their lungs grow better. It targets babies with a serious condition called severe congenital diaphragmatic hernia (CDH). The balloon helps by blocking the windpipe, which makes the lungs expand and develop more before birth.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What data supports the effectiveness of the treatment Fetal Endoscopic Tracheal Occlusion (FETO) for Congenital Diaphragmatic Hernia?

Research indicates that FETO, which involves temporarily blocking the trachea (windpipe) of a fetus, can increase survival rates and reduce complications in babies with severe congenital diaphragmatic hernia (a birth defect affecting the diaphragm). The procedure has been shown to promote lung growth and improve outcomes compared to similar cases without the treatment. ^{1 2 3 4 5}

How is the FETO Goldballoon treatment different from other treatments for congenital diaphragmatic hernia?

The FETO Goldballoon treatment is unique because it involves a minimally invasive procedure where a balloon is placed endoscopically in the fetus's trachea to promote lung growth, which is not a feature of standard postnatal care for congenital diaphragmatic hernia. ^{1 2 6 7 8}

Research Team

Yair Blumenfeld

Principal Investigator

Stanford University

Eligibility Criteria

This trial is for pregnant women aged 18-50 with a single fetus diagnosed with severe congenital diaphragmatic hernia (CDH). They must stay near LPCH Stanford, plan to deliver there, and have normal genetic testing results. Excluded are those with latex allergies, certain CDH measurements, placental abnormalities, maternal infections like HIV or Hepatitis B/C, high risk of preterm labor/delivery, significant obesity (BMI >40), or involvement in another study affecting outcomes.

Inclusion Criteria

Absence of associated fetal structural cardiac anomalies by a dedicated fetal echocardiogram

Absence of other structural anomalies by ultrasound or MRI

Able to provide written consent

Exclusion Criteria

My condition involves a diaphragmatic hernia along with other structural anomalies.

High risk for preterm labor and/or delivery

I do not have uncontrolled high blood pressure, diabetes, or other serious health issues.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Fetal Endoscopic Tracheal Occlusion (FETO) is performed in-utero and the balloon is removed prior to delivery

Duration not specified

Follow-up

Children will have follow-up visits until the age of 2 to monitor safety and effectiveness

2 years

Treatment Details

Interventions

• Balt Goldballoon (Device)

Trial Overview The FETO Goldballoon procedure by Balt medical is being tested for its effectiveness in treating severe CDH in fetuses. The balloon will be inserted endoscopically into the fetal trachea at LPCH Stanford which has specialized maternal-fetal medicine and neonatal services including ECMO and pediatric surgery.

Participant Groups

Group I: Fetal Endoscopic Tracheal Occlusion (FETO) Experimental Treatment 1 Intervention

FETO is performed in-utero and the balloon is removed prior to delivery, and children will have follow-up visits until the age of 2

Who Is Running the Clinical Trial?

Yair Blumenfeld

Lead Sponsor

Trials

1

Recruited

20+

Findings from Research

In a study involving 24 medical students, those trained through in-person lectures were significantly faster at setting up instruments for balloon removal in fetal endoluminal tracheal occlusion (FETO) compared to those trained via online video (62 seconds vs 81 seconds).

However, both training methods showed no significant difference in the time taken to locate and intubate the balloon in the trachea, indicating that while in-person training may enhance setup speed, both methods are equally effective for the critical task of balloon removal.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Simulation training for urgent postnatal fetal tracheal balloon removal: Two learning methods. Lehoczky, L., Corroenne, R., Espinoza, J., et al.[2023]

Fetal endoscopic tracheal occlusion (FETO) was performed successfully in 210 cases of congenital diaphragmatic hernia (CDH), with a high success rate of balloon placement (96.7%) and a median procedure duration of 10 minutes.

While FETO is associated with a significant risk of spontaneous preterm prelabor rupture of membranes (47.1%) and preterm delivery, it notably improves survival rates for affected fetuses, increasing survival from 24.1% to 49.1% for left-sided CDH and from 0% to 35.3% for right-sided CDH.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Severe diaphragmatic hernia treated by fetal endoscopic tracheal occlusion. Jani, JC., Nicolaides, KH., Gratacós, E., et al.[2022]

Fetoscopic endoluminal tracheal occlusion (FETO) is a feasible and safe procedure for treating severe congenital diaphragmatic hernia (CDH), with successful balloon insertion in all 11 cases studied, and no severe maternal adverse events reported.

The procedure resulted in a 45% survival rate at 90 days of age and at discharge for the treated fetuses, indicating its potential effectiveness in promoting fetal lung growth in cases of isolated left-sided CDH.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Feasibility and outcomes of fetoscopic endoluminal tracheal occlusion for severe congenital diaphragmatic hernia: A Japanese experience. Wada, S., Ozawa, K., Sugibayashi, R., et al.[2020]

In a study of 19 fetuses diagnosed with congenital diaphragmatic hernia (CDH), those who underwent fetal endoluminal balloon tracheal occlusion (FETO) had postnatal outcomes comparable to those who were not prenatally studied, suggesting that FETO can be a viable intervention even for cases with poor prognosis.

Among the 12 babies born after FETO, while some experienced significant complications requiring advanced ventilation support, the overall survival and recovery rates were promising, with no postoperative mortality reported.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of fetal intervention on postnatal management of congenital diaphragmatic hernia. Saura, L., Castañón, M., Prat, J., et al.[2014]

Fetal endoscopic tracheal occlusion (FETO) is a promising intervention for isolated congenital diaphragmatic hernia that can promote lung growth in fetuses at high risk of postnatal death, with demonstrated feasibility and safety in several fetal surgery programs.

While FETO shows an apparent increase in survival rates compared to controls, the most common complication is preterm premature rupture of membranes, which may complicate the procedure and delivery, highlighting the need for further formal trials to evaluate its efficacy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Technical aspects of fetal endoscopic tracheal occlusion for congenital diaphragmatic hernia. Deprest, J., Nicolaides, K., Done', E., et al.[2016]

Endoscopic tracheal occlusion (TO) in fetal lambs with congenital diaphragmatic hernia (CDH) successfully increased lung growth, with 5 out of 11 procedures resulting in live births and expanded lungs.

The TO group showed significantly greater lung weight compared to those without TO, suggesting that this minimally invasive technique could be a promising alternative to open fetal surgery for improving outcomes in CDH.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Tracheal obstruction in experimental diaphragmatic hernia: an endoscopic approach in the fetal lamb. Benachi, A., Dommergues, M., Delezoide, AL., et al.[2014]

In a randomized trial involving 24 pregnant women with fetuses diagnosed with severe congenital diaphragmatic hernia, fetal endoscopic tracheal occlusion did not improve survival rates compared to standard postnatal care, with survival rates of 73% and 77% respectively.

The intervention group experienced significantly more complications, including premature rupture of membranes and earlier delivery, indicating that tracheal occlusion may pose additional risks without providing survival benefits.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A randomized trial of fetal endoscopic tracheal occlusion for severe fetal congenital diaphragmatic hernia. Harrison, MR., Keller, RL., Hawgood, SB., et al.[2022]

Fetal endoscopic tracheal occlusion (FETO) using a 1.0-mm fetoscope was successfully performed in 16 fetuses with severe congenital diaphragmatic hernia (CDH), leading to a significant increase in neonatal survival rates (52.9% in the FETO group vs. 5.6% in the control group).

The study also found that FETO reduced the incidence of severe pulmonary arterial hypertension in infants, with 47.1% of the FETO group affected compared to 88.9% in the control group, indicating a potential improvement in neonatal outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison between fetal endoscopic tracheal occlusion using a 1.0-mm fetoscope and prenatal expectant management in severe congenital diaphragmatic hernia. Ruano, R., Duarte, SA., Pimenta, EJ., et al.[2016]

References

1. Ireland pubmed.ncbi.nlm.nih.gov

Simulation training for urgent postnatal fetal tracheal balloon removal: Two learning methods. [2023]

2. England pubmed.ncbi.nlm.nih.gov

Severe diaphragmatic hernia treated by fetal endoscopic tracheal occlusion. [2022]

3. Australia pubmed.ncbi.nlm.nih.gov

Feasibility and outcomes of fetoscopic endoluminal tracheal occlusion for severe congenital diaphragmatic hernia: A Japanese experience. [2020]

4. United States pubmed.ncbi.nlm.nih.gov

Impact of fetal intervention on postnatal management of congenital diaphragmatic hernia. [2014]

5. United States pubmed.ncbi.nlm.nih.gov

Technical aspects of fetal endoscopic tracheal occlusion for congenital diaphragmatic hernia. [2016]

6. England pubmed.ncbi.nlm.nih.gov

Tracheal obstruction in experimental diaphragmatic hernia: an endoscopic approach in the fetal lamb. [2014]

7. United States pubmed.ncbi.nlm.nih.gov

A randomized trial of fetal endoscopic tracheal occlusion for severe fetal congenital diaphragmatic hernia. [2022]

8. Switzerland pubmed.ncbi.nlm.nih.gov

Comparison between fetal endoscopic tracheal occlusion using a 1.0-mm fetoscope and prenatal expectant management in severe congenital diaphragmatic hernia. [2016]