A comparative analysis of ARMS (anti-reflux mucosectomy) and TIF (transoral incisionless fundoplication) in the treatment of gastroesophageal reflux disease (GERD).

Abstract

Gastroesophageal reflux disease (GERD) is a prevalent condition impacting physical and mental health, characterized by symptoms like heartburn and acid regurgitation. GERD affects 18.1-27.8% of North Americans, rising to ~ 50% under less strict criteria. Effective management of GERD is critical to improving patients' quality of life. Traditional treatments range from lifestyle modifications and pharmacological interventions to surgical approaches like laparoscopic anti-reflux surgery (LARS). Patients with erosive esophagitis receive a near 70-80% rate of "complete" symptom relief by 4 weeks using PPIs, in contrast to patients with non-erosive reflux disease (NERD), who demonstrate an intermediate response on the order of 50-60%. However, the invasiveness and associated side effects of surgical options have spurred the development of endoscopic techniques, including anti-reflux mucosectomy (ARMS) and transoral incisionless fundoplication (TIF). This review evaluates ARMS and TIF as therapeutic interventions for GERD, focusing on their risks, benefits, outcomes, and complications. ARMS is noted for shorter procedure times and fewer complications, particularly dysphagia and bleeding, making it an efficient choice for symptom control. TIF, while associated with a higher recurrence and reoperation rate, demonstrates superior long-term efficacy in medication reduction and sustained quality-of-life improvements, especially in patients without prior anti-reflux surgeries. Emerging advancements in endoscopic technologies, such as improved suturing techniques and refinements in mucosal resection, hold promise for reducing recurrence rates and enhancing procedural durability. The choice between ARMS and TIF should be tailored to individual patient needs, taking into account GERD severity, comorbidities, and surgical history. Both procedures exemplify significant advancements in minimally invasive GERD management, and ongoing innovations in endoscopic technologies are expected to further refine their safety and effectiveness. This comparative analysis provides insights into optimizing treatment selection and underscores the importance of personalized care in managing GERD.