- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03186248
Randomized Clinical Trial Comparing Short Versus Long Oesophageal Myotomy in POEM for Achalasia Cardia.
December 25, 2019 updated by: Mohan Ramchandani, Asian Institute of Gastroenterology, India
Comparison of Short Versus Long Oesophageal Myotomy in Cases With Idiopathic Achalasia: A Randomized Single Blinded Trial
Aim of this study is to compare the outcomes of a short esophageal myotomy extending from 3 cm cephalad to the EGJ, to 3 cm distal to it with a long esophageal myotomy with an additional proximal extension (at least 6 cm cephalad to the EGJ, to 3 cm distal) for POEM procedures.
Principle of POEM is to reduce pressure gradient across LES by Myotomy.
Hypothesis is that performing short myotomy will result in similar efficacy in achalasia cardia while reducing the total time taken for the procedure and ultimately will result in less complications.
Study Overview
Status
Completed
Conditions
Intervention / Treatment
Detailed Description
The primary goal of treatment of achalasia cardia (either LHM or POEM) is to divide the muscle at LES to reduce the pressure so that food bolus can pass down into the esophagus.
However, there is little evidence regarding the optimal length of this myotomy for either procedure.
During LHM the proximal length of myotomy is extended upto 6-8 cm in esophagus and distally to 3 cm in stomach.
There are no data on long term outcomes between differential proximal myotomy lengths.
The conventionally the esophageal myotomy is extended to 6-8 cm, this is based on technical considerations, as it is the maximum length that can safely be achieved via a laparoscopic, transhiatal approach.
High pressure zone of Esophago gastric junction (EGJ) complex extends for 4 cm on an average with 2 cm on esophageal side.
It is hypothesized that If shorter proximal myotomy that ablates just the EGJ complex could achieve the same normalization of EGJ physiology as a longer one, there could be several advantages to this modification.
It will take less mediastinal dissection of the esophagus, potentially reducing the chances of esophageal perforation, vagal injury and pleural tears.
During POEM, a shorter myotomy would allow for creation of a shorter submucosal tunnel, decreasing operative time along with potentially decreasing the incidence of mucosal perforations, pneumothorax and pneumoperitoneum.
Additionally, there is chance that many patients regain some esophageal peristalsis after both LHM and POEM.
Patients undergoing POEM for type 1 and type 2 Achalasia cardia will be randomised into 2 groups of short oesophageal (3 cm) and long oesophageal ( 6-8 cm) myotomy.
Study Type
Interventional
Enrollment (Actual)
71
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
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Telangana
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Hyderabad, Telangana, India, 500082
- Mohan Ramchandani
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-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
16 years to 73 years (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Type 1 and 2 achalasia with eckerd score >3 (0-12 scale achalasia) -.
- Age 18-75 years.
- Treatment naïve or history of pneumatic balloon dilatation.
- Willing and able to comply with the study procedures and provide written informed consent form to participate in the study.
Exclusion Criteria:
- Type 3 achalasia cardia or any other esophageal motility disorder
- Previous surgery of the esophagus or stomach
- Active severe esophagitis
- Large lower esophageal diverticula
- Large > 3cm hiatal hernia
- Sigmoid esophagus
- Known gastroesophageal malignancy
- Inability to tolerate sedated upper endoscopy due to cardiopulmonary instability, severe pulmonary disease or other contraindication to endoscopy
- Cirrhosis with portal hypertension, varices, and/or ascites
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Other
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Short myotomy
Per oral endoscopic myotomy extending from 3 cm cephalad to 3 cm distal to EGJ
|
General anesthesia will be administered and an esophagogastroduodenoscopy will be performed.
Mucosal incision proximal to the gastroesophageal junction (GEJ) will be identified depending on short or long myotomy.
A 1.5- to 2-cm mucosal incision will be performed after raising a submucosal wheal.
The endoscope will be inserted to create a submucosal tunnel with a combination of blunt dissection, carbon dioxide insufflation, hydro dissection and careful electrocautery.
The tunnel will be extended past the GEJ, 3 cm onto the gastric cardia.
after myotomy, the mucosal incision will then be closed using standard endoscopic clips.
|
Active Comparator: Long myotomy
Per oral endoscopic myotomy extending from 6-8cm cephalad to and 3 cm distal to EGJ.
|
General anesthesia will be administered and an esophagogastroduodenoscopy will be performed.
Mucosal incision proximal to the gastroesophageal junction (GEJ) will be identified depending on short or long myotomy.
A 1.5- to 2-cm mucosal incision will be performed after raising a submucosal wheal.
The endoscope will be inserted to create a submucosal tunnel with a combination of blunt dissection, carbon dioxide insufflation, hydro dissection and careful electrocautery.
The tunnel will be extended past the GEJ, 3 cm onto the gastric cardia.
after myotomy, the mucosal incision will then be closed using standard endoscopic clips.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Comparison of clinical efficacy between short and long myotomy groups
Time Frame: 1 year
|
Clinical success defined as Eckardt score≤3 compared between the two groups
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1 year
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Difference in operating time between short and long esophageal myotomy during POEM
Time Frame: Intra-opeartive
|
Operating time defined as time taken from mucosal incision to closure of incision after completion of the procedure.
Procedure duration was calculated in both the groups and compared
|
Intra-opeartive
|
Intraoperative adverse events
Time Frame: At the time of index procedure
|
Adverse events encountered during the procedure will be noted.
Clinical success with reference to improvement in eckerd score.
Change in LES pressure by Manometry ( Assessed at 1and 3 months) Assessment of Gastro Esophageal Reflux Disease (GERD) by Potential of Hydrogen (pH) -impedance and Endoscopy (Assessed at 1 and 3 months) Change in barium column height on timed barium Esophagogram (Assessed at pre procedure at 1 and 3 months).
|
At the time of index procedure
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LES pressure reduction
Time Frame: 1 and 3 months
|
In both the arms reduction in mean LES pressure will be compared at 1 and 3 months
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1 and 3 months
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Comparison of changes in Eckardt score
Time Frame: 1, 3 and 12 months
|
In both the groups Eckardt score ( based on symptoms of Dysphagia, Chest pain, regurgitation and weight loss) will be compared
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1, 3 and 12 months
|
Comparison of gastroesophageal Reflux disease (GERD) Rates
Time Frame: 3 months
|
Both the groups will under go clinical evaluation, esophagograstroscopy and ph metry
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3 months
|
Change in barium column height on barium esophagogram
Time Frame: 1 and 3 months
|
In both the groups time barium swallow studies will be done to evaluate the oesophageal emptying at 5 minutes.
|
1 and 3 months
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Investigators
- Principal Investigator: mahiboob sayyed, MD, Asian institute of Gastroenterology
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
June 1, 2017
Primary Completion (Actual)
February 15, 2018
Study Completion (Actual)
March 20, 2019
Study Registration Dates
First Submitted
June 9, 2017
First Submitted That Met QC Criteria
June 12, 2017
First Posted (Actual)
June 14, 2017
Study Record Updates
Last Update Posted (Actual)
December 30, 2019
Last Update Submitted That Met QC Criteria
December 25, 2019
Last Verified
December 1, 2019
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- AIG- 09/05
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
No
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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