Long-term efficacy of anti-reflux mucosectomy in patients with refractory gastroesophageal reflux disease.

BACKGROUND AND STUDY AIMS: Minimally invasive treatments have been applied for gastroesophageal reflux disease (GERD), but the long-term results are controversial. Anti-reflux mucosectomy (ARMS) is a simple endoscopic procedure that does not require the insertion of a foreign body, we provide the first report on the long-term results of ARMS.

PATIENTS AND METHODS: This was a single-center, single-arm trial, prospective study of 88 patients with proton pump inhibitor (PPI)-refractory GERD who underwent ARMS between June 2012 and June 2017. Primary outcomes were the rates of long-term effectiveness and PPI discontinuation. Secondary outcomes were to compare preoperative patient's background characteristics, questionnaire and MII-pH data to examine the predictive factors of ARMS. The clinical course was reviewed, including the need for additional treatment after ARMS.

RESULTS: ARMS produced a long-term effect in 68.3% of the patients, and PPI could be discontinued in 42% of patients. There were significant differences in age, intensity of preoperative symptoms, and acid related indicators. 45% (27/60) was reflux hypersensitivity, ARMS provided long-term effectiveness in 81% of the patients with reflux hypersensitivity. There was no significant difference in subjective symptom assessment between those with short-term and long-term efficacy. Additional treatment was administered in 23% (14/60), and scheduled at the 1-2 year follow-up.

CONCLUSIONS: ARMS showed long-term efficacy and many of the cases with short-term effects were able to maintain them. In addition, ARMS is also effective in patients with reflux hypersensitivity, and provides a treatment option that bridges the gap between surgical and medical treatment.