Antireflux Mucosectomy Band (ARM-b) in Treatment of Refractory Gastroesophageal Reflux Disease After Bariatric Surgery

Debourdeau, Antoine; Vitton, V.; Monino, Laurent; Barthet, Marc; Gonzalez, Jean‐Michel

doi:10.1007/s11695-020-04753-4

Cited by 26 publications

(21 citation statements)

References 10 publications

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“…In total, 331 patients from 12 studies underwent 335 ARMS procedures 10 11 12 18 19 20 21 22 23 24 25 26 , whereas 130 patients from three studies underwent 150 ARMA procedures 8 9 27 . Twenty-six patients underwent a second procedure: 4 underwent a second ARMS 10 12 , 20 underwent a second ARMA 9 , and 2 who failed ARMS were treated with ARMA 8 .…”

Section: Resultsmentioning

confidence: 99%

“…Twenty-six patients underwent a second procedure: 4 underwent a second ARMS 10 12 , 20 underwent a second ARMA 9 , and 2 who failed ARMS were treated with ARMA 8 . Eight studies were conducted in Asia 8 10 11 18 19 21 24 26 27 , four in Europe 12 20 23 25 , and three in North America 9 22 27 . Nine studies were reported as full-text publications 8 9 10 12 18 19 20 21 22 and six as conference abstracts 11 23 24 25 26 27 .…”

Section: Resultsmentioning

confidence: 99%

“…Eight studies were conducted in Asia 8 10 11 18 19 21 24 26 27 , four in Europe 12 20 23 25 , and three in North America 9 22 27 . Nine studies were reported as full-text publications 8 9 10 12 18 19 20 21 22 and six as conference abstracts 11 23 24 25 26 27 . Fourteen studies were single-arm, and one study compared the outcomes of ARMS with those of patients who underwent LARS 22 .…”

Section: Resultsmentioning

confidence: 99%

“…endoscopic dilation and often requires reintervention [32], whereas post-ARMS/ARMA dysphagia can be successfully controlled by small-caliber balloon dilation [8,9,11,12,[18][19][20].…”

Section: Discussionmentioning

confidence: 99%

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Antireflux mucosectomy (ARMS) and antireflux mucosal ablation (ARMA) for gastroesophageal reflux disease: a systematic review and meta-analysis

et al. 2021

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Background and study aims Antireflux mucosectomy (ARMS) and antireflux mucosal ablation (ARMA) are new endoscopic procedures for patients with gastroesophageal reflux disease (GERD). We conducted a meta-analysis to systematically assess the feasibility, clinical success, and safety of these procedures. Patients and methods We searched Embase, PubMed, and Cochrane Central from inception to October 2020. Overlapping reports, animal studies, and case reports were excluded. Our primary outcomes were clinical success and adverse events (AEs). Secondary outcomes included technical success, endoscopic esophagitis, 24-hour pH monitoring, and proton pump inhibitor (PPI) use. A random effects model was used to pool data. Results In total, 15 nonrandomized studies (12 ARMS, n = 331; 3 ARMA, n = 130) were included; 10 were conducted in patients with refractory GERD. The technical success rate was 100 %. The pooled short-term (first assessment within the first 6 months), 1-year, and 3-year clinical success rates were 78 % (95 % confidence interval [95 %CI] 70 %–85 %), 72% (95 %CI 47 %–92 %), and 73 % (95 %CI 65 %–81 %), respectively. ARMS and ARMA yielded similar clinical success. The proportion of patients off PPIs at 1 year was 64 % (95 %CI 52 %–75 %). There were significant drops (P < 0.01) in validated clinical questionnaires scores, presence of esophagitis, and acid exposure time. The most common AE (11 %, 95 %CI 8 %–15 %) was dysphagia requiring dilation (7%, 95 %CI 5 %–11 %). Four cases of perforation were recorded, all in patients undergoing ARMS. Conclusions Our meta-analysis of nonrandomized studies suggests that ARMS and ARMA are safe and effective for patients with GERD.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…endoscopic dilation and often requires reintervention [32], whereas post-ARMS/ARMA dysphagia can be successfully controlled by small-caliber balloon dilation [8,9,11,12,[18][19][20].…”

Section: Discussionmentioning

confidence: 99%

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Antireflux mucosectomy (ARMS) and antireflux mucosal ablation (ARMA) for gastroesophageal reflux disease: a systematic review and meta-analysis

et al. 2021

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“…After an average of two dilatation procedures per patient, complete resolution of dysphagia was observed, with no reoccurrence during the observation period. Dysphagia has been previously documented after ARMS and RAP technique and likely results from stricturing at LES [3,18,[27][28][29]. As demonstrated in previous studies, dysphagia is manageable endoscopically in all patients and does not appear to recur after an initial adequate dilation.…”

Section: Discussionmentioning

confidence: 68%

Feasibility of resection and plication “RAP” technique for management of medically refractory GERD in patients with altered gastric anatomy

et al. 2021

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Background and study aims Gastroesophageal reflux disease (GERD) is common, especially in patients after gastric surgery. Medical management of GERD is ineffective in up to 30 % patients and revisional gastric surgery for management of GERD is associated with higher morbidity. We aimed to assess the safety, feasibility, and efficacy of a novel endoscopic resection and plication (RAP) anti-reflux procedure for management of medically refractory GERD in patients with altered gastric anatomy. Patients and methods The RAP procedure involves endoscopic mucosal resection and full-thickness plication over the right posterior-medial axis extending 15 mm above and 20 to 30 mm below the squamocolumnar junction. Adverse events, technical feasibility, GERD health-related quality-of-life (GERD-HRQL) scores, and medication use were prospectively recorded. Results Twenty consecutive patients with previous gastric surgery underwent RAP between September 2018 and August 2020 with a median follow-up of 5.7 months. The median procedure duration was 66 minutes (IQR 53.8–89.5). RAP was technically successful in 19 patients. One patient developed gastric hemorrhage from suture dehiscence, which was managed endoscopically, and four patients developed esophageal stricture requiring endoscopic dilation. Following the RAP procedure, significant improvement in GERD-HRQL score was observed (mean 26.9, 95 %CI 23.36–30.55, P < 0.01). Fourteen of 19 patients reported > 50 % improvement in GERD-HRQL scores. Sixteen of 18 patients reported reduction in requirement for or cessation of antacid therapy. Conclusions Patients with refractory GERD after gastric surgery have limited therapeutic options. We have demonstrated that the RAP procedure is feasible, safe, and clinically effective at short-term follow-up. It provides a potential alternative to revisional surgery in patients with altered gastric anatomy.

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Gastroesophageal Reflux Disease and Metabolic Surgery

Alvárez

Silva²,

Houghton

et al. 2023

The AFS Textbook of Foregut Disease

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Antireflux Mucosectomy Band (ARM-b) in Treatment of Refractory Gastroesophageal Reflux Disease After Bariatric Surgery

Cited by 26 publications

References 10 publications

Antireflux mucosectomy (ARMS) and antireflux mucosal ablation (ARMA) for gastroesophageal reflux disease: a systematic review and meta-analysis

Antireflux mucosectomy (ARMS) and antireflux mucosal ablation (ARMA) for gastroesophageal reflux disease: a systematic review and meta-analysis

Feasibility of resection and plication “RAP” technique for management of medically refractory GERD in patients with altered gastric anatomy

Gastroesophageal Reflux Disease and Metabolic Surgery

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