Anti-reflux Mucosal Ablation Therapy Randomized Sham Control Trial for Gastroesophageal Reflux Disease

Far Eastern Memorial Hospital

Status: Not yet enrolling

Conditions: Gastroesophageal Reflux Disease

Treatments: Procedure: Antireflux mucosal ablation; Procedure: Sham procedure

Study type: Interventional

Funder types: Other

Identifiers

NCT06106100

112122-F

Details and patient eligibility

About

The goal of this randomized clinical trial is to investigate the efficacy and safety of antireflux mucosal ablation (ARMA) for patients with refractory gastroesophageal reflux disease (GERD). The trial aim to evaluate :

• Efficacy of ARMA comparing with medical treatment alone (proton pump inhibitor (PPI)), using GERD-Health Related Quality of Life Questionnaire (GERD- HRQL questionnaire), improvement of acid exposure time and DeMeester score
• Safety and complications of ARMA Participants will be randomly divided into 2 groups. The intervention group will be undergone ARMA, and the control group will be undergone sham endoscopic treatment.

The primary endpoint will be symptoms relief (GERD-HRQL decreases > 50%). The secondary endpoint will be dosage adjustment of PPI, complications, improvement of acid exposure time and DeMeester score.

Enrollment: 68 estimated patients

Sex: All

Ages: 18 to 75 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Adults aged over 18 years old
• History of GERD for over 6 months, who had received PPIs for over 6 months but still had symptoms of typical GERD symptoms (GERD-HRQL score of >8, acid reflux sensation or heartburn), and/or other symptoms as lump throat, night cough, acid related chest tightness (without other possible explanation of these symptoms)
• Acid exposure time > 6%
• DeMeester score ≥ 14.72

Exclusion criteria

• Pregnancy
• BMI>=35
• Hiatal hernia > 2cm or Flap Valve Hill grade III/IV
• GERD LA grade C/D or esophageal ulcer
• Abnormal anatomy of esophagus (esophagectomy, stricture, diverticulum)
• Barrett's esophagus with dysplasia
• Esophageal motility disorders
• History of gastroparesis
• Cirrhosis
• Esophageal and gastric varices
• Previous gastric surgery and anti-reflux procedures
• History of scleroderma or dermatomyositis
• Coagulation disorders (Bleeding tendency and coagulopathy)
• History of oncological disease (not active within 2 years)

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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68 participants in 2 patient groups

Antireflux mucosal ablation

Active Comparator group

Description:

In patients fulfilling the inclusion criteria and being randomized for ARMA, retroflexion endoscopy to visualize the cardia is performed, followed by mucosa markings with straight-fire APC catheter (ERBE Electromedizin, Tübingen, Germany) in forced coagulation mode (VIO300D, ERBE Electromedizin, Tübingen, Germany, 20W). The marking site at 1-cm and 2-cm distal to squamocolumnar junction at anterior-posterior and lesser curvature site, respectively, sparing the greater curvature site of cardia, is done. After marking, mucosal ablation (forced coagulation mode, 1L/min, 80W) is performed at marking site in a hoarse-shoe shape. Adequate ablation depth is defined as reaching the submucosal layer with blackish discolored tissue with carbonization

Treatment:

Procedure: Antireflux mucosal ablation

Sham procedure

Sham Comparator group

Description:

In patients fulfilling the inclusion criteria and being randomized for sham procedure, retroflexion endoscopy to visualize the cardia is performed. Using the straight-fire APC catheter to touch the marking sites similar to the treatment group without electrocauterization is performed

Treatment:

Procedure: Sham procedure