- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03548298
Antireflux Ablation Therapy (ARAT) for Gastroesophageal Reflux Treatment (ARAT)
Antireflux Ablation Therapy (ARAT) With Hybrid-APC (Argon Plasma Coagulation) for GERD Treatment in Patients Without Hiatal Hernia
Study Overview
Detailed Description
Gastroesophageal reflux disease is a condition in which there is a rise of gastroduodenal contents into the esophageal lumen, causing mucosal damage. Among treatments, medications are the most common used ones but up to 10%-40% doesn't respond to this type of treatment. Surgical treatment has been considered as the gold standard; however, with complications such as bleeding, perforation, or dysphagia after surgery. Moreover, not all patients are candidates to receive this type of treatment. Based on these data, new techniques have been explored in order to reduce morbidity, mortality and costs in the treatment of these patients.
Among different endoscopical treatments, ablation of EGJ is a new promising technique which can be used to perform a closure at this level throughout the scar secondary to hybrid-APC treatment, consequently decreasing gastroesophageal reflux. So, the aim of this study is to evaluate safety and efficacy of ARAT in a group of patients with confirmed GERD.
This is a quasi experimental study that will be conducted in a tertiary care center in Mexico city, Mexico. In an endoscopy department at the Mexican Institute of Social Security between January 2018 and July 2019. Those patients diagnosed with gastroesophageal reflux who are candidates and who accept this type of treatment will be evaluated. Patients who meet the inclusion criteria will be the definitive candidates. The risks and benefits of this type of endoscopic treatment will be explained as well as the potential scope of this endoscopic alternative. We will evaluate safety and efficacy of this new procedure.
The technique of the procedure involves ablation of the mucosa of the EGJ using Hybrid-APC (ARAT). The ablation field is initially marked with a Hybrid-APC. Subsequently, saline solution mixed with indigo-carmine is injected at the submucosa level to raise a submucosal bleb, followed by ablation of the mucosa along the lesser curvature. The approximate duration of the procedure is 40min.
Follow-up will include objective evaluation of reflux disease with: upper endoscopy, manometry, pHmetry, reflux questionnaire, and need of PPI (proton-pump inhibitor) dose quantification.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Ciudad de mexico, Mexico, 06720
- Centro Medico Nacional Siglo XXI, Hospital de Especialidades
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Patients of both sexes of age with a diagnosis of GERD and who are under medical treatment and who do not wish to undergo surgical treatment
- Confirmed diagnosis of GERD in the following way:
- Positive pHmetry
- Positive endoscopy (GERD with esophagitis of any degree) or negative
- Positive symptoms questionnaire for GERD
- Manometry without evidence of esophageal motor disorder
- Total or partial response to proton pump inhibitors
Exclusion Criteria:
- Patients who do not accept the signature of the informed consent
- Patients previously treated by surgery for GERD
- Pregnant women.
- Patients with hiatal hernia greater than 3 cm or Hill type IV
- Patients with esophageal motility disorders
- Patients in whom, for any reason, any antireflux surgery or endoscopic treatment has been contraindicated.
- Patients who want to undergo surgical treatment as an initial option.
- Patients with portal hypertension and the presence of esophageal varices
- Patients with hemophilia or a haematological disorder that is difficult to control
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
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Experimental: GERD without hiatal hernia
Participants with GERD without hernia hiatal will receive ARAT
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After confirmation of GERD, participants will undergo to ablation with Hybrid-APC (ARAT).
Participant will be admitted to hospital 24 hrs before procedure.
Technique consist in ablation with hybrid-APC, submucosal injection of saline solution with methylene blue at 3-4 cm from 60-70% cardias and 1 cm esophageal.
After procedure they will be kept on surveillance and will be followed-up with clinical, endoscopic, esophageal manometry and pHmetry up to 1 year after procedure.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Efficacy of ARAT with Hybrid-APC in patients with GERD without hiatal hernia
Time Frame: One year
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The efficacy of this treatment will be defined as: The decrease of ≥ 50 percent of the total percentage of acid exposure at 24 hrs (DeMeester Score)
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One year
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Safety of ARAT with hybrid-APC in patients with GERD without hiatal hernia
Time Frame: One Year
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We will document any adverse event presented during or after application of ARAT therapy
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One Year
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Collaborators and Investigators
Publications and helpful links
General Publications
- Inoue H, Ito H, Ikeda H, Sato C, Sato H, Phalanusitthepha C, Hayee B, Eleftheriadis N, Kudo SE. Anti-reflux mucosectomy for gastroesophageal reflux disease in the absence of hiatus hernia: a pilot study. Ann Gastroenterol. 2014;27(4):346-351.
- Mezerville Cantillo Ld, Cabas Sanchez J, Contreras F, Castellanos Garcia LF, Dondis JE, Galdamez J, Garcia-Maradiaga R, Grullon Dickson F, Jerez Gonzalez LE, Mayo DiBello M, Mejia Rivas MA, Moreno Padilla P, Sanchez Hernandez MA, Velasco SR, Vela MF, Valdovinos-Diaz MA, Remes-Troche JM. [Practice guideline of the Centroamerican and Carribean Association of Gastroenterology and Gastrointestinal Endoscopy for the management of gastroesophageal reflux disease]. Acta Gastroenterol Latinoam. 2014 Jun;44(2):138-53. No abstract available. Spanish.
- Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013 Mar;108(3):308-28; quiz 329. doi: 10.1038/ajg.2012.444. Epub 2013 Feb 19. No abstract available. Erratum In: Am J Gastroenterol. 2013 Oct;108(10):1672.
- Bolier EA, Kessing BF, Smout AJ, Bredenoord AJ. Systematic review: questionnaires for assessment of gastroesophageal reflux disease. Dis Esophagus. 2015 Feb-Mar;28(2):105-20. doi: 10.1111/dote.12163. Epub 2013 Dec 18.
- Hansdotter I, Bjor O, Andreasson A, Agreus L, Hellstrom P, Forsberg A, Talley NJ, Vieth M, Wallner B. Hill classification is superior to the axial length of a hiatal hernia for assessment of the mechanical anti-reflux barrier at the gastroesophageal junction. Endosc Int Open. 2016 Mar;4(3):E311-7. doi: 10.1055/s-0042-101021. Epub 2016 Feb 10.
- Villa N, Vela MF. Impedance-pH testing. Gastroenterol Clin North Am. 2013 Mar;42(1):17-26. doi: 10.1016/j.gtc.2012.11.003.
- Wileman SM, McCann S, Grant AM, Krukowski ZH, Bruce J. Medical versus surgical management for gastro-oesophageal reflux disease (GORD) in adults. Cochrane Database Syst Rev. 2010 Mar 17;(3):CD003243. doi: 10.1002/14651858.CD003243.pub2.
- Nabi Z, Reddy DN. Endoscopic Management of Gastroesophageal Reflux Disease: Revisited. Clin Endosc. 2016 Sep;49(5):408-416. doi: 10.5946/ce.2016.133. Epub 2016 Sep 30.
- Manner H, Neugebauer A, Scharpf M, Braun K, May A, Ell C, Fend F, Enderle MD. The tissue effect of argon-plasma coagulation with prior submucosal injection (Hybrid-APC) versus standard APC: A randomized ex-vivo study. United European Gastroenterol J. 2014 Oct;2(5):383-90. doi: 10.1177/2050640614544315.
- Manner H, May A, Kouti I, Pech O, Vieth M, Ell C. Efficacy and safety of Hybrid-APC for the ablation of Barrett's esophagus. Surg Endosc. 2016 Apr;30(4):1364-70. doi: 10.1007/s00464-015-4336-1. Epub 2015 Jun 24. Erratum In: Surg Endosc. 2016 Apr;30(4):1371.
- Hernandez Mondragon OV, Zamarripa Mottu RA, Garcia Contreras LF, Gutierrez Aguilar RA, Solorzano Pineda OM, Blanco Velasco G, Murcio Perez E. Clinical feasibility of a new antireflux ablation therapy on gastroesophageal reflux disease (with video). Gastrointest Endosc. 2020 Dec;92(6):1190-1201. doi: 10.1016/j.gie.2020.04.046. Epub 2020 Apr 25.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- R-2018-3601-014
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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