We are updating the design of this site. Learn more.
Show more
ClinicalTrials.gov
ClinicalTrials.gov Menu

Efficacy & Safety of Submucosal Endoscopic Myotomy With Mucosal Flap (SEMF) in the Treatment of Patients With Achalasia

This study has been completed.
Sponsor:
ClinicalTrials.gov Identifier:
NCT01438398
First Posted: September 22, 2011
Last Update Posted: May 11, 2017
The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
Information provided by (Responsible Party):
Stavros Stavropoulos, MD, Winthrop University Hospital
March 28, 2011
September 22, 2011
May 11, 2017
April 8, 2011
January 6, 2015   (Final data collection date for primary outcome measure)
  • Change in Lower esophageal sphincter pressure (LES) [ Time Frame: at 3 months post endoscopic myotomy ]
    High Resolution Esophageal Manometry will be done at 3 months to measure LES and the result will be compared to baseline or pre-endoscopic myotomy LES pressure.
  • Change in frequency of dysphagia [ Time Frame: 4 weeks post procedure ]
    Swallowing difficulty (dysphagia) will be assessed using the Modified Eckhardt Dysphagia Assessment Tool which includes asking the patient how often he/she experiences swallowing difficulty (0 = none, 1 = occasional, 2 = daily, and 3 = every meal. The score will be compared to pre-myotomy score.
  • Change in frequency of Regurgitation [ Time Frame: 4 weeks post procedure ]
    Patient will be asked how often he/she brings up swallowed liquid/solid food or regurgitates (0 = none, 1 = occasional, 2 = daily, and 3 = every meal. The score will be compared to the score prior to the procedure.
  • Change in frequency of chest pain [ Time Frame: 4 weeks post procedure ]
    The patient will be asked how often he/she experiences chest pain and the frequency (0 = none, 1 = occasional, 2 = daily, and 3 = every meal. The score will be compared to pre-myotomy score.
  • Presence of perforation [ Time Frame: During endoscopic myotomy procedure ]
    Presence of perforation that is seen during the endoscopic procedure.
  • Presence of bleeding [ Time Frame: During endoscopic myotomy procedure ]
    Occurence of bleeding during the procedure.
  • Presence of mediastinal emphysema [ Time Frame: During endoscopic myotomy procedure ]
    Presence of mediastinal emphysema will be recorded.
  • Presence of Infection [ Time Frame: 4 weeks post procedure ]
    Presence of infection within the first 4 weeks post myotomy will be recorded.
  • Development of stricture at the myotomy site. [ Time Frame: 3 months post procedure ]
    Development of stricture will be assessed by performing an upper endoscopy for patients with change in their Modified Dysphagia Score.
  • Change in Lower esophageal sphincter pressure (LES) [ Time Frame: at 3 months post endoscopic myotomy ]
    High Resolution Esophageal Manometry will be done at 3 months to measure LES and the reuslt will be compared to baseline or pre-endoscopic myotomy LES pressure.
  • Change in frequency of dysphagia [ Time Frame: 4 weeks post procedure ]
    Swallowing difficulty (dysphagia) will be assessed using the Modified Eckhardt Dysphagia Assessment Tool which includes asking the patient how often he/she experiences swallowing difficulty (0 = none, 1 = occasional, 2 = daily, and 3 = every meal. The score will be compared to pre-myotomy score.
  • Change in frequency of Regurgitation [ Time Frame: 4 weeks post procedure ]
    Patient will be asked how often he/she brings up swallowed liquid/solid food or regurgitates (0 = none, 1 = occasional, 2 = daily, and 3 = every meal. The score will be compared to the score prior to the procedure.
  • Change in frequency of chest pain [ Time Frame: 4 weeks post procedure ]
    The patient will be asked how often he/she experiences chest pain and the frequency (0 = none, 1 = occasional, 2 = daily, and 3 = every meal. The score will be compared to pre-myotomy score.
  • Presence of perforation [ Time Frame: During endoscopic myotomy procedure ]
    Presence of perforation that is seen during the endoscopic procedure.
  • Presence of bleeding [ Time Frame: During endoscopic myotomy procedure ]
    Occurence of bleeding during the procedure.
  • Presence of mediastinal emphysema [ Time Frame: During endoscopic myotomy procedure ]
    Presence of mediastinal emphysema will be recorded.
  • Presence of Infection [ Time Frame: 4 weeks post procedure ]
    Presence of infection within the first 4 weeks post myotomy will be recorded.
  • Development of stricture at the myotomy site. [ Time Frame: 3 months post procedure ]
    Development of stricture will be assessed by performing an upper endoscopy for patients with change in their Modified Dysphagia Score.
Complete list of historical versions of study NCT01438398 on ClinicalTrials.gov Archive Site
  • Presence and frequency of heartburn [ Time Frame: 4 weeks post procedure ]
    The patient will be asked for presence or absence of heartburn. If present, he/she will be asked for frequency (0 = none, 1 = occasional, 2 = daily, and 3 = every meal). The score will be compared to pre-myotomy score.
  • Frequency of use of antacids (PPI, H-2 antagonists) [ Time Frame: 4 weeks post procedure ]
    The patient will be asked if he/she is using any type of antacid. If using antacid, he/she will be asked how often he/she is using it (0 = none, 1 = occasional, 2 = daily, and 3 = every meal). The score will be compared to pre-myotomy score.
  • Change in patient's weight [ Time Frame: At 3, 6, 9, and 12 months post procedure. ]
    Post myotomy weight will be measured and recorded and compared to pre-myotomy weight.
Same as current
Not Provided
Not Provided
 
Efficacy & Safety of Submucosal Endoscopic Myotomy With Mucosal Flap (SEMF) in the Treatment of Patients With Achalasia
A Prospective, Single Center, Proof of Concept Pilot Study of the Efficacy and Safety of Submucosal Endoscopic Myotomy With Mucosal Flap (SEMF) Technique in the Treatment of Patients With Achalasia

The purpose of this study is to learn about the safety and usefulness of a procedure called endoscopic submucosal myotomy, which is a new technique in the treatment of achalasia. Achalasia is a disorder involving the lack of smooth muscle relaxation and sustained high pressure in the sphincter (muscle) of the lower esophagus. This may result in symptoms such as difficulty in swallowing, chest pain, regurgitation of food and eventually, weight loss.

For more than a decade, a laparoscopic surgical procedure known as Heller myotomy has been the primary treatment for achalasia in patients with low surgical risk. In Heller myotomy, the surgeon makes three to four small abdominal incisions, inserts tube-like instruments through them, and once inside, the junction between the esophagus and stomach is found, a lengthwise incision is made on the muscular ring surrounding the lower esophageal sphincter which weakens the muscle and the lower esophageal sphincter or muscle (LES) is then able to open more easily. However, there is an emerging field known as natural orifice (opening) transluminal (through the lumen) endoscopic surgery (NOTES). This approach involves passing an endoscope - a thin tube with a built-in camera, light and minuscule tools through the natural opening in the body, like the mouth in order to perform less invasive surgery without any external wounds or scars. The procedure is done using the Submucosal Endoscopy with Mucosal Flap (SEMF) technique which involves passing an endoscope through the mouth into the esophagus, where a small incision is made on the lining of the esophagus, known as the mucosa. A balloon is then inserted and dilated in the submucosa - the layer between the inner lining of the esophagus and the outer wall consisting of the muscle of the esophagus. Dilation of the balloon in the submucosa creates a tunnel that allows insertion of the endoscope and access to the muscle of the lower esophageal sphincter (LES). A long incision is then carefully made on the posterior portion of the muscular ring that forms the LES. The incision divides the muscle fibers of the LES, which weakens the muscle, allowing for the easier passage of food while preserving some valve function to prevent reflux of acid from the stomach into the esophagus.

The expected duration of participation is up to 10 years from the time study participants undergo the endoscopic surgical procedure.

The safety of the procedure and feasibility of the study will be measured by improvement in subjects' symptoms score, decrease in LES pressure, as well as the number and severity of complications or adverse events experienced by the subjects. A modified Eckhardt dysphagia assessment tool will be used in grading the dysphagia symptoms.
Interventional
Not Provided
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
  • Achalasia
  • Dysphagia
  • Procedure: Submucosal endoscopic myotomy with mucosal flap technique
    Submucosal Endoscopy with Mucosal Flap (SEMF) technique involves the following: (1) injecting 0.9 % normal saline solution to create a submucosal cushion, (2) tiny cut is made into the cushion, (3) Balloon will be used to dilate the opening and allow passage of endoscope in the submucosal space, (4) Upon direct visualization of the muscle fibers, the doctor will cut the circular layers of the diseased muscles, and (5) Tiny clips will be used to close the tiny cut made earlier.
    Other Names:
    • Per Oral Endoscopic Myotomy (POEM)
    • Natural Orifice Transluminal Endoscopic Surgery (NOTES)
  • Procedure: Submucosal Endoscopic Mucosal Flap (SEMF) technique
    Other Names:
    • Per Oral Endoscopic Myotomy
    • Natural Orifice Transluminal Endoscopic Surgery
Submucosal Endoscopic Mucosal Flap Technique
Submucosal Endoscopic Mucosal Flap Technique
Interventions:
  • Procedure: Submucosal endoscopic myotomy with mucosal flap technique
  • Procedure: Submucosal Endoscopic Mucosal Flap (SEMF) technique
Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Completed
120
October 22, 2015
January 6, 2015   (Final data collection date for primary outcome measure)

Inclusion Criteria:

  1. Patients 18 years or older, male or female, belonging to any race or ethnic origin
  2. Patients with manometric positive diagnosis of achalasia, with corresponding symptoms of dysphagia, regurgitation of food or chest pain
  3. Patients who are willing and competent to sign Informed Consent and to comply with study related visits and procedures

Exclusion Criteria:

  1. Patients who are below 18 years of age
  2. Presence of coagulopathy
  3. Pregnancy
  4. Patients who, in the investigator's opinion, are medically unstable, are unable to give informed consent, or whose risks outweigh the benefits of participating in the study
  5. Vulnerable subjects: Prisoners, persons with decisional incapacity, and any person who are directly involved in the study, including their immediate family members, and anybody who may have any conflict of interest such as employees of ERBE, USA.
Sexes Eligible for Study: All
18 Years and older   (Adult, Senior)
No
Contact information is only displayed when the study is recruiting subjects
United States
 
 
NCT01438398
10035
Yes
Not Provided
Not Provided
Stavros Stavropoulos, MD, Winthrop University Hospital
Winthrop University Hospital
Not Provided
Principal Investigator: Stavros N Stavropoulos, MD Winthrop University Hospital
Winthrop University Hospital
May 2017

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP