Anti-reflux mucosectomy for refractory gastroesophageal reflux disease: a systematic review and meta-analysis

Rajat Garg; Abdul Mohammed; Amandeep Singh; Mary Schleicher; Prashanthi N Thota; Tarun Rustagi; Madhusudhan R Sanaka

doi:10.1055/a-1802-0220

Anti-reflux mucosectomy for refractory gastroesophageal reflux disease: a systematic review and meta-analysis

Endosc Int Open. 2022 Jun 10;10(6):E854-E864. doi: 10.1055/a-1802-0220. eCollection 2022 Jun.

Authors

Rajat Garg¹, Abdul Mohammed², Amandeep Singh¹, Mary Schleicher³, Prashanthi N Thota¹, Tarun Rustagi⁴, Madhusudhan R Sanaka¹

Affiliations

¹ Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute; Cleveland Clinic, Cleveland, Ohio, United States.
² Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, United States.
³ Cleveland Clinic Alumni library, Cleveland Clinic, Cleveland, Ohio, United States.
⁴ Department of Gastroenterology and Hepatology, University of New Mexico, Albuquerque, New Mexico, United States.

Abstract

Background and study aims Anti-reflux mucosectomy (ARMS) is an emerging endoscopic treatment for refractory gastroesophageal reflux disease (GERD). We conducted a systematic review and meta-analysis to evaluate the safety and efficacy ARMS in refractory GERD. Methods A comprehensive search of multiple databases (through March 2020) was performed to identify studies that reported outcomes of ARMS for refractory GERD. Outcomes assessed included technical success, clinical response, and adverse events (AEs). Clinical response was defined as discontinuation (complete) or reduction (partial) of proton pump inhibitors post-ARMS at follow up. Results A total of 307 patients (mean age 46.9 [8.1] years, 41.5 % females) were included from 10 studies. The technical success and clinical response rates were 97.7 % (95 % confidence interval [CI], 94.6-99.0) and 80.1 % (95 % CI, 61.6-91.0), respectively. The pooled rate of complete and partial clinical response was 65.3 % (95 % CI, 51.4-77.0) and 21.5 % (95 % CI, 14.2-31.2), respectively. The rate of AEs was 17.2 % (95 % CI, 13.1-22.2) with most common AE being dysphagia/esophageal stricture followed by bleeding with rates of 11.4 % and 5.0 %, respectively. GERD health-related quality of life (GERD-HRQL) (mean difference [MD] = 14.9, P < 0.001), GERD questionnaire (GERD-Q) (MD = 4.85, P < 0.001) and mean acid exposure time (MD = 2.39, P = 0.01) decreased significantly post-ARMS as compared to pre-procedure. There was no difference in terms of clinical response and AEs between ARMS and ARMS with banding on subgroup analysis. Conclusions ARMS is a safe and effective procedure for treatment of refractory GERD with high rates of clinical response, acceptable safety profile and significant improvement in GERD-related quality of life. Prospective studies are needed to validate our findings.

The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Publication types

Review