{"title":"胃食管反流病的抗反流黏膜干预:内镜下抗反流治疗的新视野。","authors":"Haruhiro Inoue, Mayo Tanabe, Kazuki Yamamoto, Yohei Nishikawa, Kei Ushikubo, Ippei Tanaka, Kaori Owada, Manabu Onimaru, Takayoshi Ito, Noboru Yokoyama, Stefan Seewald","doi":"10.1159/000547947","DOIUrl":null,"url":null,"abstract":"<p><p>Anti-reflux mucosal (ARM) interventions have expanded the therapeutic spectrum for gastroesophageal reflux disease beyond pharmacologic therapy and surgery. This narrative review traces the evolution from anti-reflux mucosectomy (ARMS) and anti-reflux mucosal ablation (ARMA) to the more recently developed anti-reflux mucoplasty (ARMP) and ARMP with valve (ARMPV). Collectively, the available cohort studies and systematic reviews indicate a clinical response rate of 70-82%, with proton-pump inhibitor discontinuation achieved in up to 55% of cases. The most common adverse events are transient dysphagia (~11%) and post-procedural bleeding (~5%), both of which are manageable endoscopically. Direct defect closure in ARMP shortens the interval to symptom relief and virtually eliminates delayed bleeding, while technical refinements such as the angle booster and counter-mucosal incision have improved access and tension management. When selecting among ARM intervention techniques, we propose ARMP as the first-line option in naïve anatomy, reserving ARMA for redo or post-surgical settings where submucosal fibrosis limits application. Ongoing trials are assessing durability beyond five years, the role of full-thickness suturing that incorporates sling- and clasp-muscle fibers, and applications in bariatric or para-esophageal hernia populations. Future research priorities include standardizing ulcer dimensions to optimize shrinkage, refining patient-reported outcome measures, and clarifying cost-effectiveness relative to fundoplication and magnetic sphincter augmentation. In summary, ARM interventions offers a spectrum of flexible, minimally invasive solutions that can be tailored to individual anatomic and physiological profiles, potentially bridging the treatment gap between long-term acid suppression and surgery.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-22"},"PeriodicalIF":3.6000,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Anti-reflux mucosal intervention for gastroesophageal reflux disease: a new horizon of endoscopic anti-reflux therapy.\",\"authors\":\"Haruhiro Inoue, Mayo Tanabe, Kazuki Yamamoto, Yohei Nishikawa, Kei Ushikubo, Ippei Tanaka, Kaori Owada, Manabu Onimaru, Takayoshi Ito, Noboru Yokoyama, Stefan Seewald\",\"doi\":\"10.1159/000547947\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Anti-reflux mucosal (ARM) interventions have expanded the therapeutic spectrum for gastroesophageal reflux disease beyond pharmacologic therapy and surgery. This narrative review traces the evolution from anti-reflux mucosectomy (ARMS) and anti-reflux mucosal ablation (ARMA) to the more recently developed anti-reflux mucoplasty (ARMP) and ARMP with valve (ARMPV). Collectively, the available cohort studies and systematic reviews indicate a clinical response rate of 70-82%, with proton-pump inhibitor discontinuation achieved in up to 55% of cases. The most common adverse events are transient dysphagia (~11%) and post-procedural bleeding (~5%), both of which are manageable endoscopically. Direct defect closure in ARMP shortens the interval to symptom relief and virtually eliminates delayed bleeding, while technical refinements such as the angle booster and counter-mucosal incision have improved access and tension management. When selecting among ARM intervention techniques, we propose ARMP as the first-line option in naïve anatomy, reserving ARMA for redo or post-surgical settings where submucosal fibrosis limits application. Ongoing trials are assessing durability beyond five years, the role of full-thickness suturing that incorporates sling- and clasp-muscle fibers, and applications in bariatric or para-esophageal hernia populations. Future research priorities include standardizing ulcer dimensions to optimize shrinkage, refining patient-reported outcome measures, and clarifying cost-effectiveness relative to fundoplication and magnetic sphincter augmentation. In summary, ARM interventions offers a spectrum of flexible, minimally invasive solutions that can be tailored to individual anatomic and physiological profiles, potentially bridging the treatment gap between long-term acid suppression and surgery.</p>\",\"PeriodicalId\":11315,\"journal\":{\"name\":\"Digestion\",\"volume\":\" \",\"pages\":\"1-22\"},\"PeriodicalIF\":3.6000,\"publicationDate\":\"2025-09-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Digestion\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1159/000547947\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Digestion","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1159/000547947","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
Anti-reflux mucosal intervention for gastroesophageal reflux disease: a new horizon of endoscopic anti-reflux therapy.
Anti-reflux mucosal (ARM) interventions have expanded the therapeutic spectrum for gastroesophageal reflux disease beyond pharmacologic therapy and surgery. This narrative review traces the evolution from anti-reflux mucosectomy (ARMS) and anti-reflux mucosal ablation (ARMA) to the more recently developed anti-reflux mucoplasty (ARMP) and ARMP with valve (ARMPV). Collectively, the available cohort studies and systematic reviews indicate a clinical response rate of 70-82%, with proton-pump inhibitor discontinuation achieved in up to 55% of cases. The most common adverse events are transient dysphagia (~11%) and post-procedural bleeding (~5%), both of which are manageable endoscopically. Direct defect closure in ARMP shortens the interval to symptom relief and virtually eliminates delayed bleeding, while technical refinements such as the angle booster and counter-mucosal incision have improved access and tension management. When selecting among ARM intervention techniques, we propose ARMP as the first-line option in naïve anatomy, reserving ARMA for redo or post-surgical settings where submucosal fibrosis limits application. Ongoing trials are assessing durability beyond five years, the role of full-thickness suturing that incorporates sling- and clasp-muscle fibers, and applications in bariatric or para-esophageal hernia populations. Future research priorities include standardizing ulcer dimensions to optimize shrinkage, refining patient-reported outcome measures, and clarifying cost-effectiveness relative to fundoplication and magnetic sphincter augmentation. In summary, ARM interventions offers a spectrum of flexible, minimally invasive solutions that can be tailored to individual anatomic and physiological profiles, potentially bridging the treatment gap between long-term acid suppression and surgery.
期刊介绍:
''Digestion'' concentrates on clinical research reports: in addition to editorials and reviews, the journal features sections on Stomach/Esophagus, Bowel, Neuro-Gastroenterology, Liver/Bile, Pancreas, Metabolism/Nutrition and Gastrointestinal Oncology. Papers cover physiology in humans, metabolic studies and clinical work on the etiology, diagnosis, and therapy of human diseases. It is thus especially cut out for gastroenterologists employed in hospitals and outpatient units. Moreover, the journal''s coverage of studies on the metabolism and effects of therapeutic drugs carries considerable value for clinicians and investigators beyond the immediate field of gastroenterology.