Anti-reflux mucosectomy (ARMS) for refractory gastroesophageal reflux disease

Zhu, Xian; Shen, Jianwei

doi:10.1186/s40001-024-01789-5

Eur J Med Res

2024

DOI: 10.1186/s40001-024-01789-5

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Anti-reflux mucosectomy (ARMS) for refractory gastroesophageal reflux disease

Xian Zhu,

Jianwei Shen

Abstract: Gastroesophageal reflux disease (GERD) is one of the most common diseases seen by gastroenterologists worldwide. A significant proportion of patients have a suboptimal response to acid inhibitors, especially proton pump inhibitors and potassium-competitive acid blockers. Due to concerns regarding the safety of long-term medication, many patients are unwilling to take lifelong medication. Endoscopic antireflux management offers a minimally invasive option for GERD patients. In recent decades, there have been se… Show more

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2024

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Cited by 3 publications

References 30 publications

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Outcomes of Endoscopic Antireflux Mucosectomy for the Treatment of Gastroesophageal Reflux Disease

Galvarini,

Angeramo,

Kerman

et al. 2024

Journal of Clinical Gastroenterology

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Objective: Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal disorders in western countries. Endoscopic procedures have recently emerged as an alternative therapy to surgery for patients with GERD. The aim of this study was to determine outcomes after endoscopic antireflux mucosectomy (ARMS). Methods: A systematic review and meta-analysis were performed to analyze outcomes after ARMS. The main outcomes included patients’ satisfaction, GERD health-related quality of life, use of proton pump inhibitors, and DeMeester score. The secondary endpoint was postprocedural adverse events. A meta-analysis of proportions was used to assess the effect of each approach on different outcomes. Results: A total of 22 studies comprising 654 patients were included for analysis. The mean age of patients was 51.83 (36 to 59.39) years, and the mean body mass index was 25.06 (23.5 to 27) kg/m2. The weighted pooled proportion of patient satisfaction after ARMS was 65% (95% CI: 52%-76%). The pooled proportion of patients taking proton pump inhibitors decreases from 100% to 40.84% (P < 0.001). The mean GERD health-related quality of life scores (pre 19.48 vs post 7.90, P < 0.001) and DeMeester score (pre 44.99 vs post 15.02 P = 0.005) significantly improved after ARMS. Overall morbidity rate was 27% (95% CI: 13%-47%), with a weighted pooled proportion of perforation, stricture, and bleeding of 3% (95% CI: 2%-6%), 12% (95% CI: 9%-16%), and 6% (95% CI: 2%-17%), respectively. Conclusions: Endoscopic ARMS for GERD is associated with symptomatic improvement, reduction of medical therapy, and enhanced quality of life. Refinements of the technique, however, are needed to decrease morbidity.

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Outcomes of Endoscopic Antireflux Mucosectomy for the Treatment of Gastroesophageal Reflux Disease

Galvarini,

Angeramo,

Kerman

et al. 2024

Journal of Clinical Gastroenterology

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Advancements in GERD Treatment: Exploring Innovative Therapies

Lunawat,

Raikwar

2024

IJGHD

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Gastroesophageal Reflux Disease (GERD) stands as a prevalent and impactful gastrointes-tinal disorder, affecting a substantial portion of the global population. Characterised by the chronic backflow of stomach acid into the oesophagus, GERD presents itself with symptoms ranging from the discomfort of heartburn to more severe complications, including esophageal inflammation and respiratory issues [1]. The pervasive nature of this condition underscores the critical need for effective and evolving treatment strategies. As individuals worldwide grapple with the challenges posed by GERD, the quest for advancements in treatment options becomes paramount. The prevalence of GERD extends far beyond its physical manifestations, reaching into the realms of daily life, productivity, and overall well-being. Heartburn, regurgitation, and chest pain, hallmarks of GERD, can disrupt sleep patterns, hinder nutritional habits, and compromise the quality of life of an individual [2]. Moreover, the chronic nature of the disease raises concerns about long-term complications, such as Barrett's oesophagus and an increased risk of esophageal cancer. The burden imposed by GERD is not solely physical; it extends to psychological well-being, influencing factors like stress and anxiety. Recognising the multifaceted impact of GERD underscores the urgency of advancing treatment options to address the diverse needs of those affected [3].

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Surgical treatment strategies for gastroesophageal reflux after laparoscopic sleeve gastrectomy

Liu,

Wang,

Ran

et al. 2024

Front. Endocrinol.

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Bariatric surgery has emerged as an effective therapeutic approach for combating obesity. As the most commonly performed bariatric surgery, laparoscopic sleeve gastrectomy (LSG) has a long-term and effective outcome in weight reduction. However, studies have reported an increased incidence of gastroesophageal reflux disease (GERD) among patients after LSG. For those who fail to respond to conventional oral acid-suppressing medication, surgical intervention comes into consideration. The most commonly performed revisional surgery for sleeve gastrectomy is the Roux-en-Y gastric bypass, which can effectively alleviate the symptoms of reflux in patients and also continues to promote weight loss in patients who have not achieved satisfactory results or have experienced weight regain. In addition to this established procedure, innovative techniques such as laparoscopic magnetic sphincter augmentation (MSA) are being explored. MSA is less invasive, has good reflux treatment outcomes, and its safety and efficacy are supported by the literature, making it a promising tool for the future treatment of gastroesophageal reflux. This article also explores the role of endoscopic interventions for GERD treatment of post-sleeve gastrectomy patients. Although these methods have shown some therapeutic effect, their efficacy still requires further study due to a lack of support from more clinical data. For patients with preoperative hiatal hernia or gastroesophageal reflux symptoms, some experts now consider performing LSG combined with hiatal hernia repair or fundoplication to alleviate or prevent postoperative reflux symptoms. Both of these surgical approaches have demonstrated favorable outcomes; however, the addition of fundoplication requires further investigation regarding its long-term effects and potential postoperative complications. This article gathers and examines the current laparoscopic and endoscopic treatments for refractory gastroesophageal reflux following LSG, as well as the concurrent treatment of LSG in patients with preoperative gastroesophageal reflux or hiatal hernia.

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Anti-reflux mucosectomy (ARMS) for refractory gastroesophageal reflux disease

Cited by 3 publications

References 30 publications

Outcomes of Endoscopic Antireflux Mucosectomy for the Treatment of Gastroesophageal Reflux Disease

Outcomes of Endoscopic Antireflux Mucosectomy for the Treatment of Gastroesophageal Reflux Disease

Advancements in GERD Treatment: Exploring Innovative Therapies

Surgical treatment strategies for gastroesophageal reflux after laparoscopic sleeve gastrectomy

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