Fetoscopic Endoluminal Tracheal Occlusion

Last updated: June 5, 2025
Sponsor: University of Colorado, Denver
Overall Status: Active - Recruiting

Phase

N/A

Condition

Hernia

Pentalogy Of Cantrell

Treatment

Fetoscopic Endoluminal Tracheal Occlusion (FETO)

Clinical Study ID

NCT03674372
18-0461
  • Ages > 18
  • Female

Study Summary

The purpose of this research study is to see if the FETO surgery and FETO release (surgery to remove the device) works and is safe for babies with severe right or left Congenital Diaphragmatic Hernia (CDH). CDH is a condition in which a hole in the baby's diaphragm allows the abdominal organs to move into the chest and limit lung growth. The goal of the FETO device is to block the airway with a balloon-type device, allowing fluid to build up and help the unborn baby's lungs grow. Bigger lungs may improve the baby's quality of life.

Eligibility Criteria

Inclusion

Inclusion Criteria:

  • Pregnant women age 18 years and older, who are able to consent

  • Singleton pregnancy

Fetal

  • Normal Karyotype

  • Fetal Diagnosis of Isolated Left or Right CDH with liver up

  • Gestation at enrollment prior to 29 wks plus 6 days

  • SEVERE pulmonary hypoplasia with Ultra Sound L-sided O/E LHR < 25% or R-sided O/ELHR <45%

Exclusion

Exclusion Criteria:

  • Pregnant women <18 years of age.

  • Maternal contraindication to fetoscopic surgery or severe maternal medical conditionin pregnancy

  • Technical limitations precluding fetoscopic surgery

  • Rubber latex allergy

  • Preterm labor, cervix shortened (<15 mm at enrollment or within 24 hours of FETOballoon insertion procedure) or uterine anomaly strongly predisposing to pretermlabor, placenta previa

  • Psychosocial ineligibility, precluding consent

  • Inability to remain at FETO site during time period of tracheal occlusion, deliveryand postnatal care

Study Design

Total Participants: 10
Treatment Group(s): 1
Primary Treatment: Fetoscopic Endoluminal Tracheal Occlusion (FETO)
Phase:
Study Start date:
November 16, 2018
Estimated Completion Date:
March 31, 2030

Study Description

Despite advances in prenatal diagnosis and postnatal therapies, including extracorporeal membrane oxygenation (ECMO), inhaled nitric oxide therapy, and ventilator strategies that minimize ventilator-induced lung injury, morbidity and mortality rates for babies with severe CDH remain high. Data from Children's Hospital of Philadelphia (CHOP) between January 2006 and December 2010 for prenatal and postnatal care for 64 patients with isolated left CDH showed overall survival was 63%. Survival was 33% in patients requiring the use ECMO. Immediate morbidity/mortality is related to the severity of the pulmonary hypoplasia caused by the mass effect of the herniated abdominal contents on the developing lungs. Quantifying the severity of pulmonary hypoplasia has been performed using the observed/expected lung to head circumference ratio (O/E LHR). It is a tool validated in 354 fetuses with unilateral isolated CDH evaluated between 18 and 38 weeks gestation. For O/E LHR < 25%, survival was dismal at 1/9 or 11% (CHOP experience, not published). Published data from an interdisciplinary follow-up program at CHOP shows striking morbidities in neuromuscular tone and neurodevelopmental status.

The rationale for fetal therapy in severe CDH is to improve fetal lung growth and therefore neonatal survival. Prenatal tracheal occlusion obstructs the normal egress of lung fluid during pulmonary development leading to increased lung tissue stretch, increased cell proliferation, and accelerated lung growth. European colleagues have developed foregut endoscopy and techniques to position and remove endoluminal tracheal balloons in utero. Recently, the Belgium group published summary results of FETO showing an improved survival in 175 patients with isolated left CDH from 24% to 49%.

The investigators goal with this pilot study is to study the feasibility of implementing FETO therapy in the most severe group of fetuses with left CDH (O/E< 25%; O/E < 30%) and right CDH (O/E < 45%).

Connect with a study center

  • Children's Hospital Colorado

    Aurora, Colorado 80045
    United States

    Active - Recruiting

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