Esophageal Achalasia Clinical Trial
Official title:
Different Surgical Procedures of Peroral Endoscopic Myotomy(POEM) for Esophageal Achalasia: a Multicenter Prospective Randomized Controlled Trial
This study compares the clinical efficacy of safety of circular myotomy and full-thickness myotomy guided by peroral endoscopic in treatment of incision length of ≤7cm and of ≥7cm in achalasia patients.
Esophageal achalasia is an esophageal motor disorder, which is characterized by the absence
of esophageal peristalsis combined with a defective relaxation of the lower esophageal
sphincter (LES). The major symptoms of esophageal achalasia are dysphagia, chest pain, and
regurgitation of undigested food.
Currently, treatment options mainly focus on relief of the symptoms by reducing the LES
pressure. Pneumatic dilation is the main endoscopic therapies for esophageal achalasia.
However, the patients need repeat treatment to maintain therapeutic success and there is a
risk of perforation (1%-3%). For surgery approaches, the laparoscopic Heller's myotomy (LHM)
combined with Dor's antireflux procedure has gained considerable interest. The LHM can
sustain therapeutic effects for long-term in approximately 80% of patients.
Recently, Inoue et al. succeeded in treating achalasia endoscopically with a method called
peroral endoscopic myotomy (POEM) and achieved promising results in short-term. Technically,
POEM derived from natural orifice transluminal endoscopic surgery (NOTES) and endoscopic
submucosal dissection (ESD), in which a submucosal tunnel is created after submucosal
injection, and then an endoscopic myotomy was made at the gastroesophageal junction.
However, the clinical efficacy of safety of circular myotomy and full-thickness myotomy
guided by peroral endoscopic in treatment of incision length of ≤7cm and of ≥7cm in
achalasia patients were not determined, and there was no prospective study that compared
different surgical procedures of POEM for esophageal achalasia. Therefore, we aim to compare
the clinical efficacy of safety of circular myotomy and full-thickness myotomy guided by
peroral endoscopic in treatment of incision length of ≤7cm and of ≥7cm in achalasia
patients.
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