Endoscopic anti-reflux mucosectomy (ARMS) and Endoscopic anti-reflux ablation (ARMA) as a potential treatment for gastroesophageal reflux- single center experience

Abstract

BackgroundGastroesophageal reflux (GERD) is one of the most common disorders of the alimentary tract. Apart from troublesome symptoms, untreated GERD can lead to Barrett’s esophagus and, as a consequence, esophageal adenocarcinoma. Up to date, most typical treatment of GERD is PPI pharmacotherapy. However, in a number of cases this treatment is not sufficient or the patient does not tolerate PPI-group drugs. In these cases interventional therapy is recommended. Up to date, laparoscopic fundoplication was the only suggested option. Other, minimally-invasive procedures such as Stretta, MUSE, TIFF or EsophyX were not recommended due to the lack of clinical data. In 2014 professor H.Inoue from the Digestive Diseases Center, Showa University in Japan reported the first series of novel, endoscopic anti-reflux procedures: anti-reflux mucosectomy (ARMS) and anti-reflux mucosal ablation (ARMA).MethodsWe conducted our prospective, single center study in 30 patients ( 14 female, 16 male) with PPI-refractory GERD. All patients underwent FSSG and GERD-HRQL evaluation and GE junction pressure study prior, 6 weeks and 6 months after the procedures. After the procedure, all patients received PPI treatment for 4 weeks.ResultsWe successfully completed the procedures in all 30 patients. Mean procedure time was 42 minutes. No complications occurred. In 86,67% (26) of our patients, we achieved a total remission of GERD symptoms, FSSG scores < 6 and GERD-HRQL scores < 8. ConclusionsThe results of our study show that ARMS and ARMA are simple, safe, improve GERD-related symptoms and restore the GE junction’s anti-reflux capacity.Keywords: ARMA, ARMS, Endoscopic GERD treatment, Endoscopic surgery, Refractory GERD