Ligation-Assisted Antireflux Mucosectomy on PPI-Dependent and Cardioesophageal Sphincter Relaxed GERD: 4 Years Results of a Prospective, Multicenter Study (With Video).

Abstract

Objectives: Gastroesophageal reflux disease (GERD) is a prevalent gastrointestinal condition and ligation-assisted antireflux mucosectomy (ARMS-L) which is a modified ARMS procedure that combines mucosa ligation and endoscopic mucosectomy was evaluated as an effective and safe endoscopic procedure. Moreover, the long-term efficacy of ARMS-L requires further validation.

Methods: This prospective study included 189 patients with proton pump inhibitor (PPI)-dependent and cardioesophageal sphincter-relaxed GERD. Primary endpoint was the treatment efficacy (subjective and objective symptom): the total GERD-HRQL questionnaire score and the rate of PPI discontinuation at the follow-up. Secondary endpoints included improvements in GERD-Q scores, HRM, 24-h pH impedance monitoring, and AFS grade, as objective measures of hiatal disruption.

Results: All patients underwent ARMS-L successfully and the average duration of follow-up are 48 months. 70.3% (133/189) of patients achieved a ≥ 50% improvement in the total GERD-HRQL score. HRM parameters improved significantly, with LES resting pressure increasing from 6.3 to 6.6 mmHg and LES residual pressure from 5.9 to 7.2 mmHg. 24-h pH impedance monitoring showed significant improvement, with the DeMeester score decreasing from 27.23 to 8.63. 70.9% of patients stopped PPIs, and 29.1% used PPIs occasionally. The improvement in the DeMeester score was lower in patients with AFS grade 1 (from 24.13 to 9.74) compared with those with grade 2 (from 27.98 to 7.86) and grade 3 (from 28.86 to 8.90).

Conclusions: ARMS-L reduced GERD symptoms and improved the quality of life for a long time, particularly in PPI-dependent and cardioesophageal sphincter relaxed GERD patients.