Clinical Trials Logo

Clinical Trial Summary

Per-oral endoscopic myotomy has been used as a treatment method of esophageal achalasia. Patients who undergo POEM as a treatment of achalasia are often presented with development of reflux as a side effect of the surgery. Patients are then in need to use proton pump inhibitor drugs as a long term treatment of the reflux symptoms. Physiotherapy aimed on the strengthening of diaphragm and lower esophageal region is effective in gastroesophageal reflux disease. Therefore we are expecting positive effect of physiotherapy in post POEM patients with reflux symptoms and the possible reduction of PPI drug usage need. The aim of the study is to objectify the effect of physiotherapy, to describe in detail the used physiotherapeutic techniques and to develop practical guidelines for the treatment of patients after POEM with GERD.


Clinical Trial Description

The goal per-oral endoscopic myotomy (POEM) is to release a non-relaxing, often spastic lower esophageal sphincter (LES). During POEM an incision of the esophageal muscle layer (m.propria) is performed using the submucosal tunnel technique. A complication of POEM is the development of reflux, which occurs in up to 50% of patients (within 12 months), with the occurrence of severe esophagitis being rare. However, patients are treated with proton pump inhibitors (PPIs) after POEM, either daily or on-demand. As a result, patients after POEM are regularly monitored for the possible development of symptomatic or asymptomatic reflux, which (if left untreated) can lead to the development of complications, including Barrett's esophagus, a known precancerous lesion. The main reason for reflux in patients after POEM is an insufficient function of the LES, which is formed not only by the smooth muscle of the esophagus, but also by the skeletal muscle- diaphragm, which remains intact during the POEM itself. Together, these two structures form a major component of antireflux barriers. Since the crural part of the diaphragm is a skeletal striated muscle, it is a trainable muscle. The study will involve 30 patients after POEM with diagnosed reflux. Three months after POEM patients undergo follow-up examinations using high resolution manometry, 24hours pH test for reflux and gastroscopy. Based on the results of the examination in the 3rd month after the POEM, those who meet the inclusion criteria, will be offered to participate in this study. Patients will be asked to fill in the quality of life questionnaire of patients after POEM and the validated questionnaire for patients with reflux disease. Patients will be randomized in 2 groups (15 in both arms, ratio 1:1), one group will undergo 4 months of physiotherapy treatment using PPI on demand, second group will be a control group undergoing standard treatment of reflux symptoms with PPI on demand. This study will evaluate the effect of standard treatment of post-POEM esophageal reflux compared to the effect of physiotherapy using dynamic neuromuscular stabilization in post-POEM patients with esophageal reflux. There is currently no study looking at the effect of physiotherapy in post-POEM patients, we believe this could be a beneficial study. If this study demonstrates that physiotherapy alleviates the symptoms of post-POEM reflux, it could be one of the official methods of treatment for this group of patients and thus significantly increase their quality of life. ;


Study Design


Related Conditions & MeSH terms


NCT number NCT05326113
Study type Interventional
Source Institute for Clinical and Experimental Medicine
Contact Katerina Mádle
Phone 00420606613462
Email katerina.madle@gmail.com
Status Recruiting
Phase N/A
Start date October 31, 2021
Completion date January 18, 2025

See also
  Status Clinical Trial Phase
Completed NCT01399476 - Endoscopic Myotomy of the Lower Esophageal Sphincter for Achalasia N/A
Recruiting NCT06044155 - redoPOEM : Failure of a First POEM
Recruiting NCT02989883 - Clinical Outcomes of Peroral Endoscopic Myotomy N/A
Terminated NCT02606578 - Achalasia Patient Reported Outcomes
Recruiting NCT01793922 - POEM Trial: Multi-center Study Comparing Endoscopic Pneumodilation and Per Oral Endoscopic Myotomy (POEM) N/A
Recruiting NCT01302288 - Endolumenal Partial Myotomy for the Treatment of Esophageal Achalasia Phase 2
Terminated NCT03875365 - Institutional Outcome Data From Per-oral Plication of the Esophagus
Enrolling by invitation NCT02770859 - Per-Oral Endoscopic Myotomy (POEM) for the Treatment of Achalasia, Database Repository
Recruiting NCT05905016 - Prospective Evaluation of the Clinical Utility of Peroral Endoscopic Myotomy for Gastrointestinal Motility Disorders
Completed NCT01692106 - A Clinical Study of Per Oral Endoscopic Myotomy (POEM) in Patients Suffering From Achalasia N/A
Completed NCT01405469 - Endoscopic Peroral Myotomy for Treatment of Achalasia N/A
Completed NCT01402518 - Per-Oral Endoscopic Myotomy
Not yet recruiting NCT00790465 - Efficacy of Dark Chocolate in Achalasia Patients Phase 1/Phase 2
Recruiting NCT01799967 - Minimally Invasive Surgery of the Gastro-esophageal Junction
Terminated NCT00604942 - vMII for Measurement of Oesophageal Bolus Transport and Reflux N/A
Not yet recruiting NCT06042127 - POEM-F for Achalasia International Study N/A
Completed NCT04752670 - ConMed Beamer Study
Completed NCT02314741 - Peroral Endoscopic Myotomy (POEM) for Esophageal Motility N/A
Completed NCT01933373 - A Prospective Study Comparing Two Reconstructive Operation Techniques After Myotomy of Achalasia N/A
Enrolling by invitation NCT03654066 - Botox or Botox With Esophageal Dilation in Patients With Achalasia Phase 4