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HINTS AND TIPS
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Trial registered on ANZCTR
Registration number
ACTRN12620000410954
Ethics application status
Approved
Date submitted
15/03/2020
Date registered
27/03/2020
Date last updated
27/03/2020
Date data sharing statement initially provided
27/03/2020
Type of registration
Retrospectively registered
Titles & IDs
Public title
Use of novel device in the endoscopic treatment of Zenker's Diverticulum patients
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Scientific title
Functional Lumen Imaging Probe demonstrates reduced cricopharyngeal distensibility and myotomy-induced improvement in Zenker’s Diverticulum patients
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Secondary ID [1]
300800
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Nil known
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Universal Trial Number (UTN)
U1111-1249-8086
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Zenker diverticulum
316672
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Condition category
Condition code
Oral and Gastrointestinal
314913
314913
0
0
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Other diseases of the mouth, teeth, oesophagus, digestive system including liver and colon
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Intervention/exposure
Study type
Observational
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Patient registry
False
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Target follow-up duration
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Target follow-up type
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Description of intervention(s) / exposure
FLIP (functional lumen imaging probe) measures intestinal distensibility measurements. It has been used in a variety of clinical applications, and has previously been shown to discriminate outcomes from treatment of other oesophageal pathologies including achalasia and oesophageal strictures.
At our facility, FLIP measurements were performed pre- and post-therapeutic endoscopy procedures for dysphagic patients as part of standard care. This includes Zenker patients as well as patients with benign oesophageal strictures and achalasia.
For Zenker patients as relevant to our study, FLIP measurements will be performed during flexible endoscopy cricopharyngeal myotomy. Measurements will be performed by a senior gastroenterologist with expertise in oesophageal pathologies and advanced endoscopic techniques. Patients will be anaesthetised during the procedure by an anaesthesiologist(as is standard for endoscopic myotomy) and FLIP measurements will be taken immediately pre- and post-myotomy. FLIP measurements add approximately 10 minutes to procedure length, and will be performed as a single assessment during the procedure.
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Intervention code [1]
317122
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Not applicable
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Comparator / control treatment
A historical control group was used. Our facility prospectively maintains data on distensibility measurements. Non-dysphagic patients were identified who had presented for review at our outpatient clinic and had distensibility measurements taken during routine diagnostic gastroscopy. These patients were screened for and data collected between February 2012 and February 2015.
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Control group
Historical
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Outcomes
Primary outcome [1]
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Cricopharyngeal distensibility as assessed by FLIP measurements.
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Assessment method [1]
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0
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Timepoint [1]
323228
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Measurements will be taken at the time of gastroscopy for both groups. For the Zenker's diverticulum patients, FLIP measurements will be performed immediately before and after endoscopy myotomy. For the control group, measurements will be performed on completion of the diagnostic gastroscopy.
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Secondary outcome [1]
381231
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Clinical assessment of symptom severity (using modified Dakkak and Bennett scale)
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Assessment method [1]
381231
0
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Timepoint [1]
381231
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Symptoms will be assessed pre-procedure and then again at 1 month post-myotomy.
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Secondary outcome [2]
381232
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Pre-operative and post-operative diverticulum size (classified using the Morton & Bartley classification system on the basis of barium swallow studies)
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Assessment method [2]
381232
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Timepoint [2]
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Diverticulum size will be assessed pre-procedure then at 1 month post-myotomy.
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Secondary outcome [3]
381233
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Procedural time measured from time of anaesthesia commencement to cessation. This was determined from routinely collected endoscopy suite documentation of time in/time out.
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Assessment method [3]
381233
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Timepoint [3]
381233
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At completion of gastroscopy.
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Secondary outcome [4]
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Adverse events including major (e.g. perforation, bleeding requiring transfusion, sepsis) and minor (e.g. pain, minor bleeding). These will be assessed through medical records.
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Assessment method [4]
381234
0
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Timepoint [4]
381234
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Adverse events are screened for during routine follow up of patients up to 12 months following procedure.
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Eligibility
Key inclusion criteria
Treatment naive Zenker's diverticulum patients undergoing flexible endoscopic cricopharyngeal myotomy
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Patients without radiologically proven presence of Zenker diverticulum.
Patients who have previously had endoscopic or surgical treatment of Zenker diverticulum
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Study design
Purpose
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Duration
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Selection
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Timing
Both
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
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Actual
3/12/2018
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Date of last participant enrolment
Anticipated
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Actual
28/12/2018
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Date of last data collection
Anticipated
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Actual
1/03/2019
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Sample size
Target
10
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Accrual to date
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Final
11
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Recruitment in Australia
Recruitment state(s)
NSW
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Recruitment hospital [1]
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St George Hospital - Kogarah
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Recruitment hospital [2]
16127
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St George Private Hospital - Kogarah
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Recruitment postcode(s) [1]
29645
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2217 - Kogarah
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Funding & Sponsors
Funding source category [1]
305257
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Hospital
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Name [1]
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St George Hospital
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Address [1]
305257
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Gray St, Kogarah NSW 2217
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Country [1]
305257
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Australia
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Primary sponsor type
Individual
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Name
Linda Zhang
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Address
St George Hospital
Gray St Kogarah NSW 2217
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Country
Australia
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Secondary sponsor category [1]
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None
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Name [1]
305618
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Address [1]
305618
0
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Country [1]
305618
0
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
305599
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Human Research Ethics Committee Prince of Wales Hospital
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Ethics committee address [1]
305599
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G71 East Wing Edmund Blacket Building Prince of Wales Hospital Randwick NSW 2031
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Ethics committee country [1]
305599
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Australia
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Date submitted for ethics approval [1]
305599
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27/09/2018
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Approval date [1]
305599
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09/11/2018
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Ethics approval number [1]
305599
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HREC ref no 18/199
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Summary
Brief summary
Zenker diverticulum is a herniation of the oesophageal mucosa resulting in pouch formation which can result in dysphagia and spontaneous regurgitation. Treatment with flexible endoscopic myotomy demonstrates lower morbidity compared to previous modalities. However, there is no established standard approach with unknown optimal technique. While the principal is to cut the cricopharyngeal muscle, a careful balance needs to be achieved to not cause perforation, while noting that an incomplete myotomy leads to higher recurrence rates. Intra-procedural measurement of distensibility across the Zenker's using the endoscopic Functional Lumen Imaging Probe (FLIP) could allow real-time determination of whether further incision will be required. Through retrospective review of medical records we hope to determine the feasibility of intra-procedural FLIP measurements in these patients, and assess whether there is a correlation between changes of distensibility following myotomy with symptoms and pouch size. We expect approximately 10 patients and hope to show that intra-procedural measurements will help to guide extent of myotomy to minimise risk of perforation as well as recurrence.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Dr Linda Zhang
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Address
100918
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St George Hospital
Gray St Kogarah
NSW 2217
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Country
100918
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Australia
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Phone
100918
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+61413168598
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Fax
100918
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Email
100918
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[email protected]
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Contact person for public queries
Name
100919
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Linda Zhang
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Address
100919
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St George Hospital
Gray St Kogarah NSW 2217
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Country
100919
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Australia
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Phone
100919
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+61 0291131111
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Fax
100919
0
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Email
100919
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[email protected]
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Contact person for scientific queries
Name
100920
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Linda Zhang
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Address
100920
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St George Hospital
Gray St Kogarah
NSW 2217
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Country
100920
0
Australia
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Phone
100920
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+610291131111
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Fax
100920
0
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Email
100920
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[email protected]
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
Only grouped data will be shared.
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What supporting documents are/will be available?
No Supporting Document Provided
Doc. No.
Type
Citation
Link
Email
Other Details
Attachment
7365
Ethical approval
379465-(Uploaded-15-03-2020-14-16-53)-Study-related document.pdf
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
Download to PDF