Gastric Reflux
Conditions
Brief summary
This observational study will be conducted among 43 patients of both sexes in each group Study participants will be of the age more than 18 years * STUDY PROCEDURE-Pre-defined technique to avoid bias and confounding due to multiple factors * All the poem procedures will be performed by posterior route * Preservation of sling fibers will be attempted in all the cases to avoid heterogeneity * Length of esophageal myotomy will be kept constant (4-6cm) * Double scope technique will be utilized to confirm the gastric extent of myotomy First evaluation at 1-month: based on Symptoms • Second evaluation: at 6 months by * Objective evaluation: UGI endoscopy, High resolution manometry, Timed barium swallow * Eckardt score, GERD-HRQL * 24-hour pH study with manual readings
Detailed description
• The primary outcome of the study is the incidence of significant reflux esophagitis (≥grade B) in cases with standard and extended gastric myotomies at 6 months after POEM Secondary outcomes: * Significant esophageal acid exposure (\>6%) as defined by the revised Lyon consensus * Symptoms of GERD (GERD HRQL) * Clinical efficacy (Eckardt score≤3) * Esophageal emptying at 5 minutes * High resolution manometry parameters (LES pressures and Integrated relaxation pressure in mmhg units) * All the secondary outcomes will be assessed at 6 months after poem procedure Eligibility: Eligible cases with idiopathic achalasia (type I and II) will be enrolled in the study and randomized (1:1 ratio) in two groups according to the length of gastric myotomies INCLUSION CRITERIA : * Idiopathic achalasia (type I and II) * Age ≥18 years * Willing to provide informed consent and comply with the study protocol Exclusion criteria * Ineligibility for POEM procedure * Spastic esophageal motility disorders * Presence of esophageal diverticulum and hiatal hernia * Prior hellers myotomy with or with out fundoplication
Interventions
POEM is a form of natural orifice transluminal endoscopic surgery that is completed by creating a submucosal tunnel in the lower part of esophagus to reach the inner circular muscle bundles of the LES to perform myotomy, while preserving the outer longitudinal muscle bundles. The result is decreased resting pressure of the LES, facilitating the passage of ingested material.
Sponsors
Asian Institute of Gastroenterology, India
Study design
Observational model
CASE_ONLY
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Idiopathic achalasia (type I and II) * Age ≥18 years * Willing to provide informed consent and comply with the study protocol
Exclusion criteria
* Ineligibility for POEM procedure * Spastic esophageal motility disorders * Presence of esophageal diverticulum and hiatal hernia * Prior hellers myotomy with or with out fundoplication
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Impact of Gastric Length of myotomy during poem on Gastroesophageal reflux | 6 months | incidence of reflux esophagitis \>grade B in cases with standard and extended gastric myotomies after POEM |
| Ph metry test for gastroesophageal reflux | 6 months | Significant esophageal acid exposure(\> 6%) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Symptoms of Gastro esophageal reflux disease | 6 months | Health related quality of life questionaires or scores in numericals |
| High resolution manometry parameters(LES pressures and IRP) | 6 months | lower esophageal sphincter pressure will be assesed by mmhg, integrated resting pressure in mmhg units |
Countries
India
Outcome results
None listed