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A Prospective Study Comparing Two Reconstructive Operation Techniques After Myotomy of Achalasia

This study has been completed.
Ersta Hospital, Sweden
Information provided by (Responsible Party):
Lars Lundell, Karolinska University Hospital Identifier:
First received: June 19, 2013
Last updated: August 30, 2013
Last verified: August 2013
Achalasia is a rare motor disorder of the gastroesophageal junction which is associated with an increased pressure of the esophageal sphincter. This leads to impairment to swallow and heartburn. Esophageal myotomy, which is a surgical longitudinal incision of the esophageal muscle layer extending over to the gastroesophageal junction is the treatment of choice for achalasia. In order to prevent reflux of stomach content into the esophagus this has to be combined with an antireflux procedure where the upper part of the stomach (fundus) is wrapped around the esophagus (fundoplication). This procedure can be performed with the wrapped fundus either in front of the esophagus (Dor procedure) or behind (Toupet). The latter introduces an angulation of the esophagus, which possibly may lead to an impairment of swallowing ability and passage of food to the stomach. On the other hand, the Toupet procedure may give a better control of reflux. The primary endpoint of the study is symptoms of impaired swallowing 1 year after treatment. Secondary outcomes include reflux (pH measurements in the esophagus), radiological imaging of swallowing and quality of life.

Condition Intervention
Procedure: Toupet
Procedure: Dor

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Prospective Randomized Trial Comparing Two Reconstructive Operation Techniques After Myotomy of Achalasia. Comparing Toupet Versus DOR.

Resource links provided by NLM:

Further study details as provided by Karolinska University Hospital:

Primary Outcome Measures:
  • Dysphagia symptoms according to Eckhardt [ Time Frame: up to five years follow up ]

Secondary Outcome Measures:
  • Ambulatory esophageal PH [ Time Frame: One and five years follow up ]
  • Health-related quality of life according to Velanovich [ Time Frame: One and five years follow up ]
  • Timed barium esophagogram at 1, 2 and 5 minutes [ Time Frame: One and five years follow up ]

Enrollment: 25
Study Start Date: May 2007
Study Completion Date: December 2012
Primary Completion Date: December 2011 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Toupet
Laparoscopic Myotomy + Toupet 180 degree partial posterior fundoplication.
Procedure: Toupet
Laparoscopic posterior partial fundoplication plus myotomy.
Other Name: Laparascopic posterior partial fundoplication plus myotomy.
Experimental: Dor
Laparoscopic Myotomy + Dor anterior partial fundoplication. 90 degree partial fundoplication being the standard of care.
Procedure: Dor
Anterior partial fundoplication plus myotomy.
Other Name: Anterior partial fundoplication plus myotomy.

Detailed Description:
By the end of 2012 40 patients have been enrolled and passed the one year follow up.

Ages Eligible for Study:   18 Years to 80 Years   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • >18 years of age
  • Typical achalasia according to manometry
  • Eckhardt score >3
  • Informed consent

Exclusion Criteria:

  • Severe comorbidity precluding surgery
  • Pseudo achalasia
  • Inability to participate in follow-up
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Please refer to this study by its identifier: NCT01933373

Karolinska University Hospital
Stockholm, Sweden, 14186
Sponsors and Collaborators
Karolinska University Hospital
Ersta Hospital, Sweden
Principal Investigator: Lars R Lundell, Professor Gastrocentrum Karolinska University Hospital, Stockholm Sweden
  More Information

Publications automatically indexed to this study by Identifier (NCT Number):
Responsible Party: Lars Lundell, Professor, Karolinska University Hospital Identifier: NCT01933373     History of Changes
Other Study ID Numbers: 2007/595-32
Study First Received: June 19, 2013
Last Updated: August 30, 2013

Keywords provided by Karolinska University Hospital:

Additional relevant MeSH terms:
Esophageal Achalasia
Esophageal Motility Disorders
Deglutition Disorders
Esophageal Diseases
Gastrointestinal Diseases
Digestive System Diseases processed this record on May 23, 2017