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Esophageal Motility DisordersU-POEMNCT06918730

U-POEM vs CO2-POEM

A study testing U-POEM and CO2-POEM in people with Esophageal Motility Disorders, run by AdventHealth at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Multicenter randomized trial comparing post-procedural pain intensity after Per-Oral endoscopic myotomy (POEM) between two types of standard of care insufflation methods (CO2 vs Underwater). Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Esophageal Motility Disorders
What is being tested?
U-POEM and CO2-POEM
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
34 participants
Where
1 siteUnited States
Study dates
11 Feb 2025to 3 Mar 2026
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age 18 years or older
  • Ability to provide informed consent
  • Patient scheduled to undergo POEM procedure for esophageal dysmotility

Who cannot join

  • Inability to provide informed consent
  • Any contraindication to POEM as per the endoscopist at the time of endoscopic evaluation (example: esophageal stricture, malignancy).
  • Any standard contraindication, including pregnancy, to anesthesia and/or colonoscopy

Trial locations and contacts

1 site in 1 country.

United States1 site
  • AdventHealth Orlando

    Orlando, Florida, 32804

Other trials in United States

About this study

Official title: Prospective Randomized Controlled Trial (RCT)Comparing Clinical Outcomes Between Underwater Versus Carbon Dioxide Insufflation During Peroral Endoscopic Myotomy (U-POEM Trial)

Multicenter randomized trial comparing post-procedural pain intensity after Per-Oral endoscopic myotomy (POEM) between two types of standard of care insufflation methods (CO2 vs Underwater).

POEM is routinely performed under carbon dioxide insufflation (CO2-POEM) as this gas is more rapidly absorbed than air, which has been shown to reduce gas-related complications.

Read more

Water immersion for luminal distension of the GI tract as opposed to carbon dioxide insufflation has been shown to be associated with improved patient satisfaction, safety profile and even higher detection of polyps during colonoscopy in randomized trials

Aim 1. The primary aim is to compare post-procedural pain following U-POEM vs. CO2-POEM.

Aim 2. Compare the proportion of patients that require post-procedural admission for pain management.

Aim 3. Compare the need for analgesic medications for pain control in patients undergoing U-POEM vs. CO2-POEM.

Aim 4. Compare technical and clinical success between U-POEM vs. CO2-POEM. Technical success is defined as successful completion of the procedure whereas clinical success will be defined as an Eckardt score ≤ 3 at the time of follow-up.

Aim 5. Compare and evaluate procedural characteristics between the two groups.

  1. Compare procedural time between U-POEM and CO2-POEM.
  2. Compare the mean number of coagulations with hemostatic forceps for active intraprocedural bleeding and the mean number of times in which a device besides an electrosurgical knife was required for prophylactic ablation of vessels.
  3. Adverse event rate (i.e. bleeding, perforation).
Being tested
U-POEM, CO2-POEM
Keywords
POEM, U-POEM, CO2-POEM, Esophageal motility
Medical subject headings
Esophageal Motility Disorders

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • U-POEMProcedure or surgery

    Water immersion for luminal distension of the GI tract as opposed to carbon dioxide insufflation

  • CO2-POEMProcedure or surgery

    POEM is routinely performed under carbon dioxide insufflation (CO2-POEM) as this gas is more rapidly absorbed than air.

Study groups in NCT06918730
Study groupRoleWhat they receive
CO2-POEMExperimentalPOEM is routinely performed under carbon dioxide insufflation (CO2-POEM) as this gas is more rapidly absorbed than air.
Receives: Procedure: CO2-POEM
U-POEMExperimentalWater immersion for luminal distension of the GI tract as opposed to carbon dioxide insufflation
Receives: Procedure: U-POEM

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Pain measurement outcomes post procedure: Numeric Pain Scale

    The primary aim is to compare post-procedural pain following U-POEM vs. CO2-POEM.

    Using Numeric Pain Scale (NPS)

    NPS is a numeric scale ranging from 0 (no pain) to 10 (worst pain imaginable)

    Measured: Through study completion. Before Endoscopic Procedure (Day 1), Post Endoscopic Procedure (Day 1), and follow-up visit (Up to 6 months post procedure)

  2. Pain measurement outcomes post procedure: Pain Quality Assessment Scale

    The primary aim is to compare post-procedural pain following U-POEM vs. CO2-POEM.

    Pain Quality Assessment Scale (PQAS).

    PQAS is a numeric scale ranging from 0 (no pain) to 10 (worst pain imaginable)

    Measured: Through study completion. Before Endoscopic Procedure (Day 1), Post Endoscopic Procedure (Day 1), and follow-up visit (Up to 6 months post procedure)

Secondary outcomes (4)
  1. Readmission rate

    Compare the proportion of patients that require post-procedural admission for pain management.

    Measured: 30 days post procedure (+- 7 days)

  2. Analgesic medication needs

    Compare the need for analgesic medications for pain control in patients undergoing U-POEM vs. CO2-POEM through electronic medical records.

    Measured: 30 days post procedure (+- 7 days)

  3. Compare technical success between POEM procedures

    Compare clinical success between U-POEM vs. CO2-POEM. Clinical success will be defined as an Eckardt score ≤ 3 at the time of follow-up.

    Achalasia Severity is measured by the Eckardt Score which consists of 4 questions used to characterize the severity of achalasia.

    The questions include symptoms related to:

    • Dysphagia
    • Chest pain
    • Regurgitation
    • Weight loss.

    Each question is assigned a score from 0 to 3 based on the patient's self-reported response.

    The overall score ranges from 0-12, with anything less than 3 meaning no active symptoms, and anything higher than a 3 suggestive of active symptoms.

    Measured: up to 6 months

  4. Compare technical success between POEM procedures

    Compare technical success between U-POEM vs. CO2-POEM. Technical success is defined as successful completion of the procedure.

    Measured: up to 6 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted9 Apr 2025
  2. Study start11 Feb 2025
  3. Primary completion30 Oct 2025
  4. Study completion3 Mar 2026

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Participant
Enrolment
34 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06918730
Sponsor's protocol ID
2263975
Acronym
U-POEM
Status last verified
Sep 2025
First submitted
21 Mar 2025
Last updated
15 May 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Ponds FA, Fockens P, Lei A, Neuhaus H, Beyna T, Kandler J, Frieling T, Chiu PWY, Wu JCY, Wong VWY, Costamagna G, Familiari P, Kahrilas PJ, Pandolfino JE, Smout AJPM, Bredenoord AJ. Effect of Peroral Endoscopic Myotomy vs Pneumatic Dilation on Symptom Severity and Treatment Outcomes Among Treatment-Naive Patients With Achalasia: A Randomized Clinical Trial. JAMA. 2019 Jul 9;322(2):134-144. doi: 10.1001/jama.2019.8859.

    PubMed 31287522
  • Werner YB, Hakanson B, Martinek J, Repici A, von Rahden BHA, Bredenoord AJ, Bisschops R, Messmann H, Vollberg MC, Noder T, Kersten JF, Mann O, Izbicki J, Pazdro A, Fumagalli U, Rosati R, Germer CT, Schijven MP, Emmermann A, von Renteln D, Fockens P, Boeckxstaens G, Rosch T. Endoscopic or Surgical Myotomy in Patients with Idiopathic Achalasia. N Engl J Med. 2019 Dec 5;381(23):2219-2229. doi: 10.1056/NEJMoa1905380.

    PubMed 31800987
  • Yang D, Bechara R, Dunst CM, Konda VJA. AGA Clinical Practice Update on Advances in Per-Oral Endoscopic Myotomy (POEM) and Remaining Questions-What We Have Learned in the Past Decade: Expert Review. Gastroenterology. 2024 Dec;167(7):1483-1490. doi: 10.1053/j.gastro.2024.08.038. Epub 2024 Oct 16.

    PubMed 39425737
  • Reddy CA, Tavakkoli A, Abdul-Hussein M, Almazan E, Vosoughi K, Ichkhanian Y, Al-Hawary M, Chang AC, Chen JW, Korsnes S, Elmunzer BJ, Khashab MA, Law R. Clinical impact of routine esophagram after peroral endoscopic myotomy. Gastrointest Endosc. 2021 Jan;93(1):102-106. doi: 10.1016/j.gie.2020.05.046. Epub 2020 Jun 3.

    PubMed 32504702
  • Benias PC, Korrapati P, Raphael KL, D'Souza LS, Inamdar S, Trindade AJ, Lee C, Kumbhari V, Sejpal DV, Okolo P, Khashab MA, Miller L, Carr-Locke D. Safety and feasibility of performing peroral endoscopic myotomy as an outpatient procedure with same-day discharge. Gastrointest Endosc. 2019 Oct;90(4):570-578. doi: 10.1016/j.gie.2019.04.247. Epub 2019 May 10.

    PubMed 31078571
  • Cloutier Z, Mann A, Doumouras AG, Hong D. Same-day discharge is safe and feasible following POEM surgery for esophageal motility disorders. Surg Endosc. 2021 Jul;35(7):3398-3404. doi: 10.1007/s00464-020-07781-4. Epub 2020 Jul 9.

    PubMed 32648037
  • Maeda Y, Hirasawa D, Fujita N, Obana T, Sugawara T, Ohira T, Harada Y, Yamagata T, Suzuki K, Koike Y, Yamamoto Y, Kusaka Z, Noda Y. A pilot study to assess mediastinal emphysema after esophageal endoscopic submucosal dissection with carbon dioxide insufflation. Endoscopy. 2012 Jun;44(6):565-71. doi: 10.1055/s-0031-1291664. Epub 2012 Mar 9.

    PubMed 22407383
  • Pannu D, Yang D, Abbitt PL, Draganov PV. Prospective evaluation of CT esophagram findings after peroral endoscopic myotomy. Gastrointest Endosc. 2016 Sep;84(3):408-15. doi: 10.1016/j.gie.2016.02.022. Epub 2016 Feb 22.

    PubMed 26907745
  • Lee JY, Lim CH, Kim DH, Jung HY, Youn YH, Jung DH, Park JC, Moon HS, Hong SJ; Therapeutic Endoscopy and Instrument for Functional Gastrointestinal Disorders Study Group Under the Korean Society of Neurogastroenterology and Motility. Adverse Events Associated With Peroral Endoscopic Myotomy Affecting Extended Hospital Stay: A Multi-center Retrospective Study in South Korea. J Neurogastroenterol Motil. 2022 Apr 30;28(2):247-254. doi: 10.5056/jnm21081.

    PubMed 35362451
  • Cadoni S, Gallittu P, Sanna S, Fanari V, Porcedda ML, Erriu M, Leung FW. A two-center randomized controlled trial of water-aided colonoscopy versus air insufflation colonoscopy. Endoscopy. 2014 Mar;46(3):212-8. doi: 10.1055/s-0033-1353604. Epub 2013 Nov 11.

    PubMed 24218307
  • Hsieh YH, Koo M, Leung FW. A patient-blinded randomized, controlled trial comparing air insufflation, water immersion, and water exchange during minimally sedated colonoscopy. Am J Gastroenterol. 2014 Sep;109(9):1390-400. doi: 10.1038/ajg.2014.126. Epub 2014 Jun 3.

    PubMed 24890443
  • Binmoeller KF, Bhat YM. Underwater peroral endoscopic myotomy. Gastrointest Endosc. 2016 Feb;83(2):454. doi: 10.1016/j.gie.2015.08.066. Epub 2015 Sep 8. No abstract available.

    PubMed 26358328
  • Uchima H, Colan J, Marin I, Moreno V, Larios G, Tazi R, Serra J. Underwater peroral endoscopic myotomy (u-POEM) after tension capnoperitoneum and capnothorax during POEM. Endoscopy. 2020 Nov;52(11):E396-E397. doi: 10.1055/a-1144-2547. Epub 2020 Apr 17. No abstract available.

    PubMed 32303086
  • Capogreco A, de Sire R, Massimi D, Alfarone L, Maselli R, Hassan C, Repici A. Underwater coagulation using hybrid knife in peroral endoscopic myotomy for achalasia. Endoscopy. 2024 Jul;56(7):547-548. doi: 10.1055/a-2292-8460. Epub 2024 Jun 27. No abstract available.

    PubMed 38936349
  • Yang D, Pannu D, Zhang Q, White JD, Draganov PV. Evaluation of anesthesia management, feasibility and efficacy of peroral endoscopic myotomy (POEM) for achalasia performed in the endoscopy unit. Endosc Int Open. 2015 Aug;3(4):E289-95. doi: 10.1055/s-0034-1391965. Epub 2015 May 5.

    PubMed 26357672

Questions about this trial

What is this clinical trial studying?

A study testing U-POEM and CO2-POEM in people with Esophageal Motility Disorders, run by AdventHealth at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 15 May 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Pain measurement outcomes post procedure: Numeric Pain Scale (time frame: Through study completion. Before Endoscopic Procedure (Day 1), Post Endoscopic Procedure (Day 1), and follow-up visit (Up to 6 months post procedure)). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06918730, which also lists 23 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 15 May 2026.

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