A pilot study on anti-reflux mucoplasty with valve as novel endoscopic therapy for gastroesophageal reflux disease

Abstract

Background and aims

Endoscopic anti-reflux therapies like anti-reflux mucosectomy (ARMS) and anti-reflux mucosal ablation have shown efficacy for gastroesophageal reflux disease (GERD) in systematic reviews and meta-analyses. Anti-reflux mucoplasty (ARM-P), a refinement of ARMS, incorporates immediate closure of the resection site to reduce complications. Recently, anti-reflux mucosal valvuloplasty (ARMV), which employs endoscopic submucosal dissection to create a mucosal valve, was introduced but retains ARMS's limitations, requiring extensive incisions (three-quarters to four-fifths circumference). To address these challenges, we developed anti-reflux mucoplasty with valve (ARM-P/V), integrating ARMV's valvuloplasty with ARM-P's closure technique to improve safety and reduce complications. This pilot study evaluates the safety, feasibility, and efficacy of ARM-P/V.

Methods

This retrospective study reviewed data from patients undergoing ARM-P/V for proton pump inhibitor (PPI)-refractory or PPI-dependent GERD at Showa University Koto Toyosu Hospital, Tokyo, from April to August 2024. Symptom severity and quality of life were assessed using validated questionnaires (GERD-Health Related Quality of Life Questionnaire [GERD-HRQL], GERD Questionnaire [GerdQ], and Frequency Scale for the Symptoms of GERD [FSSG]), comparing pre- and post-treatment scores. PPI discontinuation rates were also analyzed.

Results

Eighteen patients (mean age 55.4 years) underwent ARM-P/V. Within 3 months, 72.2% (13/18) reduced or discontinued PPI use. GERD-HRQL scores improved from 20.3 to 10.9 (p = 0.004), GerdQ from 10.4 to 6.9 (p < 0.001), and FSSG from 24.0 to 13.2 (p < 0.001). No severe complications (Clavien-Dindo Grade ≥3), delayed bleeding or dysphagia requiring balloon dilation were reported.

Conclusions

ARM-P/V demonstrates safety, technical feasibility, and short-term efficacy in GERD treatment. As a refinement of ARMV, it offers a promising alternative to current techniques.