A Prospective Randomized Trial Comparing Laparoscopic Nissen Against Anterior Partial Fundoplication in Treating Gastroesophageal Reflux Disease Among Chinese Patients

Study Overview
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Brief Summary
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The aim of this study is to compare the effectiveness of laparoscopic Nissen against anterior partial fundoplication in the control of gastroesophageal reflux disease among Chinese patients Study hypothesis Laparoscopic Nissen is comparable to anterior partial fundoplication in the control of gastroesophageal reflux disease

Detailed Description
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The incidence of gastroesophageal reflux disease (GERD) is rising among Asian population. A recent systematic review showed among Chinese population, the prevalence of GERD can be up to 5% (2). Currently, the standard treatment for GERD is acid suppression using proton pump inhibitors (PPI) which can achieve a symptomatic relief of more than 90%. However, more than 50% of patients with GERD will required long term PPI. As the usual occurrence of GERD is at the age of 40 to 50, the need of long term PPI among these young adults renders them playing a sick role for a long period of time. This imposed a major impact on these patients' quality of life, and a significant medical expenditure to the society. Since Rudolf Nissen first reported the use of fundoplication as a treatment of gastroesophageal reflux disease in 1956, there has been a development in variety of different fundoplication. It can be classified into a complete or partial wrapping at the lower esophageal sphincter around the esophago-gastric junction (EGJ). From the results of numerous randomized studies, Fundoplication is considered as an alternative to long term proton pump inhibitors. Recent controversies abound upon the use of partial or complete fundoplication. Several randomized studies reported that a partial fundoplication can reduce the incidence of post-operative dysphagia. However, this benefit is off-set by an increase in the incidence of recurrence. From our retrospective review on 28 patients treated by laparoscopic fundoplication, the recurrence of GERD is significantly higher in patients treated with partial compared to a complete fundoplication. The effectiveness of partial against complete Nissen fundoplication in control of reflux among Chinese patients is still unknown. Our study aimed to compare Laparoscopic Nissen fundoplication against Anterior partial on the control of gastroesophageal reflux disease.

Official Title
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A Prospective Randomized Trial Comparing Laparoscopic Nissen Against Anterior Partial Fundoplication in Treating Gastroesophageal Reflux Disease Among Chinese Patients

Conditions
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Gastroesophageal Reflux Disease

Intervention / Treatment
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* Procedure: Laparoscopic Nissen Fundoplication
* Procedure: Laparoscopic anterior partial fundoplication


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age > 16 and < 70 Gastroesophageal reflux disease (GERD) as evidence by Typical symptoms including heartburn &/or acid regurgitation &/or acid in throat Good response to PPI therapy Defined as a complete cessation of GERD symptoms (as above) with 4 weeks of high dose PPI PPI - standardized to Esomeprazole 40mg daily Not able to wean off PPI to on-demand regimen Exclusion Criteria: Achalasia Moribund patients Pregnancy Previous gastrectomy / esophagectomy Informed consent not available Non-Chinese ethnic group Patients with hiatus hernia > 3cm (measured by endoscopy & / or manometry)

Ages Eligible for Study
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Minimum Age: 16 Years
Maximum Age: 70 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
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Intervention/Treatment |
| --- |
|Procedure: Laparoscopic Nissen Fundoplication|nan|
|Procedure: Laparoscopic anterior partial fundoplication|nan|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Recurrence of gastroesophageal reflux disease that required medication therapy |  | 5 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 1. Dysphagia - measured by the 4-point Likert scale (0 - no dysphagia,1 - mild dysphagia, 2 - moderate dysphagia, 3 - severe dysphagia) |  |  | 
| 2. Ability to bloat / belch |  |  | 
| 3. Overall Satisfaction - (0 - Very satisfactory, 1 - Good, 2 - no comment, 3 - Unsatisfactory) |  |  | 
| 4. Quality of life score - measure by SF36 before operation, 6 months and 12 months after operation |  |  | 
| 5. GERD related QoL assessment |  |  | 
| 6. Perioperative outcomes - hospital stay, operative time, morbidity, mortality |  |  | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Gastroesophageal reflux disease, Laparoscopic Nissen Fundoplication, Laparoscopic anterior partial fundoplication