Antireflux Ablation Therapy (ARAT) Vs Antireflux Mucosectomy (ARMS) In The Management Of Gastroesophageal Reflux Disease

Coordinación de Investigación en Salud, Mexico

Overview

Gastroesophageal reflux disease has a high global prevalence, proton pump inhibitors are the cornerstone in the management but 10-20% of the patients are refractory to these, surgical treatment being an option of treatment in these patient but its associated with high morbidity, as well as a greater possibility of early therapeutic failure, for these reasons new therapies are in development being the mucosectomy with band and ablation of the esophagogastric junction with hybrid argon plasma options widely available that can offer a viable therapeutic option for patients with difficult control of symptoms or those who does not want to receive continuous medical treatment or surgical treatment. The aims of the study is to evaluate the safety and efficacy of this new techniques in the management or gastroesophageal reflux disease without hiatal hernia.

Gastroesophageal reflux disease is a disease with high global prevalence, reaching rates of 19.6 and 40% in our country, for which it is one of the most common reasons for medical care and although a clinical response is obtained in an 80-90% of patients with the use of proton pump inhibitors, the rest of the patients represents a medical challenge; surgical and endoscopic treatment being within the treatment options, the former having a high related morbidity (perforation, vagal nerve injury, postoperative dysphagia, etc), its duration is suboptimal and a second operation is associated with more surgical complications and morbidity, as well as a greater possibility of early therapeutic failure. For all these reasons, new endoluminal therapies have begun to be planned, including transoral fundoplication and radiofrequency ablation of the esophagogastric junction, these with controversial results and with the need of the use of special accessories and instruments that are not widely available; mucosectomy with band and ablation of the esophagogastric junction with hybrid argon plasma are widely available procedures in medical centers, offering a viable therapeutic option for patients with difficult control of symptoms or those who does not want to receive continuous medical treatment or surgical treatment.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Conditions

Gastroesophageal Reflux Disease

Interventions

Ablation of the gastroesophageal junction with hybrid argon plasmaPROCEDURE

In the management group with argon plasma hybrid after marking 270 degrees of the esophagogastric junction, submucosal elevation and argon plasma burn of the marked and elevated area is performed.

mucosectomy with band of the gastroesophageal junctionPROCEDURE

In the management group with mucosectomy after marking 270 degrees of the esophagogastric junction, a submucosal elevation of the marked area is performed to subsequently perform ligation and resection with a hot snare below the ligation area.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 90 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Patients of both sexes over 18 years and under 90 years with a diagnosis of GERD and who are under medical treatment and who do not want surgical treatment. * Confirmed diagnosis of GERD as follows: Positive pHmetry. Positive endoscopy (Esophagitis grade C, D, stenosis or EB) * Esophagogastric junction Hill I-III * Total or partial response to proton pump inhibitors * Patient who does not wish to take medication for the treatment of gastroesophageal reflux in the long term or indefinitely or refractory GERD Exclusion Criteria: * Patients who do not accept the signature of the informed consent * Postoperative fundoplication patients for GERD * Patients with extraesophageal symptoms. * Pregnant women. * Patients with hiatal hernia larger than 3 cm or Hill type IV. * Patients with major esophageal motility disorders. * Patients with portal hypertension and presence of esophageal varices * Patients with hemophilia or some haematological disorder that is difficult to control * Patients with malignant pathology of the esophagus or Gastroesophageal Junction (GEJ).

Locations (1)

Centro Medico Nacional Siglo XXI Hospital de Especialidades

Mexico City, Mexico City, Mexico

Outcomes

Primary Outcomes

efficacy of management with ARAT and ARMS in reducing the total percent acid exposure time

the investigators will compare the percentage of improvement in esophageal Ph metry before and after procedure

Time frame: 3, 6 and 12 months

Data from ClinicalTrials.gov

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