Snare-assisted POEM for Treatment of Esophageal Achalasia
- Conditions
- Esophageal Achalasia
- Interventions
- Device: knife-assisted POEMDevice: snare-assisted POEM
- Registration Number
- NCT02999451
- Lead Sponsor
- First Affiliated Hospital, Sun Yat-Sen University
- Brief Summary
POEM is a new intervention for the treatment of achalasia and has been reported to relieve the dysphagia symptom effectively. Although the cost of POEM method is less than the method of Laparoscopic Heller Myotomy and Fundoplication, it is still of an economic burden for the patients with achalasia. In this trial, investigators plan to use snare to assist POEM procedure, to observe the safety, efficacy and cost-effectiveness of this method, compared with other knifes-assisted procedure.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 75
- Age between 18-70 years
- Diagnosed as achalasia base on high resolution manometry, barium esophagram and Upper endoscopy
- Signed written informed consent
- ASA class > Ⅲ
- Previous endoscopic or surgical treatment for achalasia
- Esophageal malignancy
- Pregnant
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description conventional group knife-assisted POEM knife-assisted POEM snare group snare-assisted POEM snare-assisted POEM
- Primary Outcome Measures
Name Time Method Clinical success rates 12 months after treatment Clinical success is defined as a post-POEM Eckardt score ≤3 without additional treatment (Eckardt AJ et al, Nat Rev Gastroenterol Hepatol 2011).
- Secondary Outcome Measures
Name Time Method Procedure time POEM procedure Procedure time is measured from the start of submucosal injection until mucosal entry closure.
Gastroesophageal reflux disease questionnaire (GerdQ) score baseline, 3 months and 12 months after treatment The GerdQ has been developed as a tool to facilitate the symptom-based diagnosis of GERD. Scores ranging from 0 to 3 were applied for the four positive predictors (heartburn, regurgitation, sleep disturbance due to reflux symptoms and use of over-the-counter medications for reflux symptoms) and from 3 to 0 for two negative predictors (epigastric pain and nausea). The GerdQ score was calculated as the sum of these scores, giving a total score ranging from 0 to 18. A total GerdQ score \>7 is considered indicative of significant GERD symptoms (Jones R et al, Aliment Pharmacol Ther 2009).
The volume of intraoperative bleeding POEM procedure Postoperative pain requiring the use of tramadol Through hospital stay after procedure, an average of 2-7 days Pain related to POEM procedure requiring the use of tramadol pain medication.
Procedure-related adverse events baseline to 12 months after treatment Adverse events are defined and graded according to the American Society for Gastrointestinal Endoscopy lexicon (Cotton PB et al, Gastrointest Endosc 2010). Incidental findings of pneumoperitoneum, pneumothorax, pneumomediastinum, pleural effusion on postoperative imaging, and subcutaneous emphysema were documented while not considered as adverse events.
The use of hemostatic forceps POEM procedure Total hospital costs of treatment per participants Through hospital stay after procedure, an average of 2-7 days The length of postoperative hospital stay Through hospital stay after procedure, an average of 2-7 daysc Eckardt score baseline, 3 months and 12 months after treatment The Eckardt score assesses the severity of achalasia symptoms by combining the sum of symptom frequency scores for dysphagia, regurgitation, and chest pain and a weight loss score. Each component can be graded from 0 to 3 points. The total range is 0 to 12, with higher scores indicating more severe symptoms (Eckardt AJ et al, Nat Rev Gastroenterol Hepatol 2011).
Manometry parameters baseline and 3 months after treatment Manometry parameters include lower esophageal sphincter (LES) pressure and integrated relaxation pressure (IRP) on high resolution manometry.
Reflux esophagitis on post-POEM endoscopy 3 months after treatment The severity of reflux esophagitis is graded according to the Los Angeles classification (Armstrong D et al, Gastroenterology 1996).
Maximum esophageal diameter on barium esophagram baseline and 3 months after treatment
Trial Locations
- Locations (1)
First Affiliated Hospital of Sun Yat-sen University
🇨🇳Guangzhou, Guangdong, China