Endoscopic treatment of proton pump inhibitor‐refractory gastroesophageal reflux disease with anti‐reflux mucosectomy: Experience of 109 cases

Abstract

Objectives Some patients with gastroesophageal reflux disease (GERD) are refractory to proton pump inhibitor (PPI) therapy. Anti‐reflux mucosectomy (ARMS) is a minimally invasive endoscopic procedure for treatment of GERD. In this study, we retrospectively evaluated the outcomes of ARMS performed in patients with PPI‐refractory GERD at our institution. Methods A total of 109 patients with PPI‐refractory GERD who underwent ARMS were retrospectively reviewed. Pre‐ and post‐ARMS questionnaire scores, acid exposure time (AET), DeMeester score, proximal extent, and PPI discontinuation rate were compared. Results There was a significant improvement in the symptom score (P < 0.01) and 40–50% of patients were able to discontinue PPI after ARMS. In patients who were followed up for 3 years, sustained improvement in subjective symptoms was observed. AET and DeMeester score significantly improved after ARMS (P < 0.01); however, there was no significant improvement in proximal extent (P = 0.0846). Conclusions Anti‐reflux mucosectomy is an effective minimally invasive therapy for patients with PPI‐refractory GERD. The therapeutic efficacy is attributable to suppression of acid backflow due to contraction of the scar tissue in cardia.

Endoscopic Management of Gastroesophageal Reflux Disease

“…Sumi et al published a series of 109 patients with PPI-refractory GERD who underwent ARMS. 73 The mean procedural time for ARMS was 55 minutes. GERD symptom scores significantly improved at 6-month and 1-year time intervals.…”

“…Rates of dysphagia following ARMS are variably reported, but range from 6 to 16%. [73][74][75][76] Sumi et al reported an improvement in their dysphagia rate from 14.4 to 4.8% when they modified their mucosectomy to a butterfly shape by leaving a small amount of mucosa in the lesser curvature. 73 Given the relative novelty of this procedure, data to support indications and contraindications, use in special populations, and predictors for procedural success are not available and represent future areas of research on this topic.…”

Optimal management of severe symptomatic gastroesophageal reflux disease

“…Creating a mucosal resection in the cardia of the stomach through an endoscope may result in scarring and tightening of the lower oesophageal sphincter, termed anti-reflux mucosectomy. In a report of 109 patients from Japan with PPI refractory GERD, the procedure improved symptoms and about half stopped PPI, but no controlled data are available [115].…”

How much ARMS twisting is needed to treat GERD?

“…Although beginners need to learn basic endoscopic procedures as operators, the effect of the learning curve is considered to be small for an operator who has been performing endoscopic procedures. In addition, there is a report of anti-reflux mucosal ablation, 2 which shows that there is room for further simplification.…”