Endoscopic Myotomy for the Treatment of Achalasia (Motility Disorder) of the Esophagus - POEM Procedure

Study Overview
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Brief Summary
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Endoscopic Esophageal Myotomy (POEM), the research procedure, splits the lower esophageal sphincter muscle fibers from the inside of the esophagus, avoiding several abdominal incisions (belly area cuts), by using an endoscope to create a small cut at the most inner layer of the esophagus to expose the esophageal sphincter muscle fibers from the inside of the esophagus. The investigators are studying whether subjects who undergo Endoscopic Esophageal Myotomy will have similar functional outcome, and at the same time less pain, scar formation and wound infection than with laparoscopic or open surgery.

Detailed Description
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The purpose of this research study is to find out more about a less invasive way of doing the surgical procedure (esophageal myotomy) to treat Achalasia. Achalasia is a disease of the esophagus, where the lower esophageal sphincter fails to relax, causing difficulty in swallowing. Esophageal myotomy (Heller myotomy) is surgically cutting the muscle fibers of the esophageal sphincter to allow passage of food into the stomach. Esophageal myotomy is routinely done either by laparoscopic or open surgery. Laparoscopic surgery requires several (about 4 to 5) small incisions in the abdomen to allow the camera and surgical instruments to be introduced into the abdominal cavity to perform the myotomy. In open surgery, a 6- to 8-inch abdominal incision is made to gain access to the abdominal cavity to perform the myotomy. Endoscopic Esophageal Myotomy (POEM), the research procedure, splits the lower esophageal sphincter muscle fibers from the inside of the esophagus, avoiding several abdominal incisions. The researchers are investigating how safe Endoscopic Esophageal Myotomy is and how well it works. Additionally, the researchers will assess the level of pain and the amount of scarring subjects has after this surgery.

Official Title
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Endoscopic Esophageal Myotomy for the Treatment of Achalasia

Conditions
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Achalasia

Intervention / Treatment
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* Procedure: Endoscopic Esophageal Myotomy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosis of achalasia Age 18-65 ASA class 1-2 Exclusion Criteria: Pregnant women Any prior surgical or endoscopic treatment for achalasia except dilation less than 20 mm Patients who are taking immunosuppressive medications or are immunocompromised Patients on blood thinners or aspirin or with history of bleeding disorders ASA class III patients

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: treatment group<br>Patients undergoing POEM procedure | Procedure: Endoscopic Esophageal Myotomy<br>* Endoscopic mucosotomy, with submucosal tunneling and circular muscular fiber myotomy and mucosa closure.<br>* Other names: Endoscopic Heller Myotomy;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Improvement of quality of life and dysphagia symptoms | Patients will be given a quality of life and dysphagia questionare before surgery and at 3 and 6 months after surgery | 6 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Dysphagia, Achalasia, Endoscopic, Myotomy, Heller, NOTES, POEM