Pilot study on anti-reflux mucoplasty: Advancing endoscopic anti-reflux therapy for gastroesophageal reflux disease

Haruhiro Inoue; Kazuki Yamamoto; Yuto Shimamura; Daisuke Azuma; Kei Ushikubo; Hiroki Okada; Yoshiaki Kimoto; Yohei Nishikawa; Ippei Tanaka; Mayo Tanabe; Manabu Onimaru; Marc Julius Navarro

doi:10.1111/den.14711

Pilot study on anti-reflux mucoplasty: Advancing endoscopic anti-reflux therapy for gastroesophageal reflux disease

Dig Endosc. 2023 Oct 29. doi: 10.1111/den.14711. Online ahead of print.

Authors

Affiliations

¹ Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan.
² Institute of Digestive and Liver Diseases, St. Luke's Medical Center, Quezon City, Philippines.

PMID: 37899073
DOI: 10.1111/den.14711

Abstract

Objectives: Anti-reflux mucosectomy (ARMS) and anti-reflux mucosal ablation (ARMA) were developed as interventions for proton pump inhibitor (PPI)-refractory/-dependent gastroesophageal reflux disease (GERD). Although ARMS and ARMA are established treatments for PPI-refractory GERD, reliance on natural healing for ulcer scar formation introduces uncertainty and bleeding risk. To address these issues, we introduced a novel approach called anti-reflux mucoplasty (ARM-P), which involves immediate closure of mucosal defects following mucosectomy. This pilot study aims to evaluate the safety, feasibility, and efficacy of ARM-P.

Methods: A retrospective single-center study was conducted using prospectively collected data from October 2022 to July 2023. Patients with PPI-refractory/-dependent GERD who underwent ARM-P were included. The study evaluated technical success of ARM-P, before and after ARM-P GERD-Health Related Quality of Life Questionnaire, GerdQ, and Frequency Scale for the Symptoms of GERD scores, along with PPI discontinuation and endoscopic esophagogastric junction morphology.

Results: A total of 20 patients with a median age of 61.5 years underwent the ARM-P procedure. The procedure achieved 100% technical success without adverse events. After ARM-P, 55.0% discontinued PPI usage and 15.0% reduced PPI dose by half. Median GERD-Health Related Quality of Life Questionnaire score improved from 21 to 6 (P = 0.0026), median GerdQ score improved from 9 to 7 (P = 0.0022), and median Frequency Scale for the Symptoms of GERD score decreased from 16 to 7 (P = 0.0003). Median Hill's Classification significantly improved from grade III to grade I (P = 0.0001).

Conclusions: This study presents the first pilot report of ARM-P, demonstrating its procedural safety, technical feasibility, and short-term efficacy.

Keywords: anti-reflux mucoplasty; anti-reflux mucosal ablation; anti-reflux mucosectomy; endoscopic anti-reflux therapy; gastroesophageal reflux disease.