MEErKAT: MEsenteric Excision and Kono-s Anastomosis Trial

What the researchers are looking at:

MEErKAT is trying to find out if Mesenteric Excision or Kono-S Anastomosis, or both, are better than current types of ileocaecal surgery in helping to prevent the recurrence of Crohn’s Disease. Previous research shows that these surgical methods are safe and both methods are already often used. So far over 100 participants are part of the study.

People who have a section of bowel removed due to Crohn’s, have both ends of the remaining bowel surgically joined together. Crohn’s comes back for many people, often near the join. The mesentery is an organ which holds the gut in place and supplies the bowel with blood, lymphatics, nerves and other essentials. Many surgeons feel that the type of surgery used to remove mesentery and join bowel ends can affect the chances of further disease.

Mesenteric Excision removes more of the mesentery during surgery than is usual at present.

Kono-S Anastomosis locates the join away from the mesentery.

This UK-wide research is taking place in England and Scotland, and preparations are being made to include hospitals in Wales and further hospitals in England. Hospitals in Northern Ireland would also be very welcome. Patients in the trial are already being treated at:

University Hospitals Birmingham NHS Foundation Trust
Bolton NHS Foundation Trust
University Hospitals Bristol and Weston NHS Foundation Trust
Calderdale and Huddersfield NHS Foundation Trust
Chelsea and Westminster Hospital NHS Foundation Trust
Royal Cornwall Hospitals NHS Trust
University Hospitals of Coventry and Warwickshire NHS Trust
University Hospitals of Derby and Burton NHS Foundation Trust
Royal Devon University Healthcare NHS Foundation Trust (formerly Royal Devon and Exeter NHS Foundation Trust)
The Dudley Group NHS Foundation Trust
NHS Greater Glasgow and Clyde
Guy's and St Thomas' NHS Foundation Trust
Kettering General Hospital NHS Foundation Trust
University Hospitals of Leicester NHS Trust
London North West University Healthcare NHS Trust
Manchester University NHS Foundation Trust
Norfolk and Norwich University Hospitals NHS Foundation Trust
Oxford University Hospitals NHS Foundation Trust
University Hospitals Plymouth NHS Trust
Sandwell and West Birmingham NHS Trust
Sheffield Teaching Hospitals NHS Foundation Trust
University Hospital Southampton NHS Foundation Trust
Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust

These hospitals are where people who need ileocaecal surgery may agree to participate. MEErKAT has trained over 30 surgeons in using the Kono-S procedure and this training will be offered to surgeons who wish to be involved in future.

The methods of surgery that each person has will be selected by chance from one of four possible options which are:

• Mesenteric Excision with the current join method
• OR Mesenteric Excision with Kono-S join
• OR current mesentery method with Kono-S join
• OR current mesentery with current join methods.

The inside of each person’s bowel is medically examined around a year later to check for any recurrence of Crohn’s.

Researchers are studying the surgical and medical data for all people participating and are comparing disease recurrence rates for each type of surgery. Where a person suffers a recurrence of Crohn’s the researchers will note to which part of the bowel the disease has returned.

MEErKAT will last for three years with continuous patient involvement in the way the research is run. Committees overseeing the research include patient representatives. Patient participant information will be available and can be provided in languages needed to ensure people understand what participation in MEErKAT will mean for them. People participating will receive all the normal hospital care and advice specific to each individual and they can choose to be updated about how the research progressed at the end of the trial. Due to the way data must be analysed, the researchers won’t find out, until the end of the study, if any surgery resulted in less recurrence of Crohn's disease.

What the researchers think this might mean for people with Crohn’s and Colitis:

Half of all people receiving ileocaecal surgery for Crohn’s suffer a recurrence of the disease. This research aims to test if Mesenteric Excision and/or the Kono-S Join are better than usual methods in preventing recurrence. If they are better, then use of these methods will help prevent post-operative recurrence of Crohn’s.