Comparing Conventional and Full-Thickness Peroral Endoscopic Myotomy for Treating Esophageal Achalasia

What this Trial Is About

This research aims to compare the effectiveness and safety of two different peroral endoscopic myotomy POEM techniques in treating patients with achalasia types I and II. The study focuses on conventional myotomy, which involves cutting only the inner circular muscle layer, and a modified approach called full-thickness myotomy, which includes cutting the full thickness of the muscle bundle. The goal is to determine which method better improves symptoms and reduces complications for achalasia patients. Participants will receive one of two procedures conventional myotomy or full-thickness myotomy. Both procedures start with a mucosal incision and creation of a submucosal tunnel near the gastroesophageal junction. The conventional method cuts only the circular muscle, while the full-thickness method additionally cuts the full muscle layer near the junction. After myotomy, the mucosal incision is closed with clips. The study compares these techniques by randomly assigning participants to one of the two groups. During the study, participants will be closely monitored before, during, and after the procedure. Researchers will measure therapeutic success at six months following treatment, along with procedure time, pressure changes in the esophagus, esophagogram results, complication rates, severity of esophagitis, and pain after POEM. Other assessments include endoscopic scoring and hospitalization duration. These evaluations will help determine the safety and benefits of each myotomy approach over a six-month period.

Assessment of Different Modified POEM for Achalasia