Antireflux mucosectomy (ARMS) and antireflux mucosal ablation (ARMA) for gastroesophageal reflux disease: a systematic review and meta-analysis

Abstract

Background and study aims Antireflux mucosectomy (ARMS) and antireflux mucosal ablation (ARMA) are new endoscopic procedures for patients with gastroesophageal reflux disease (GERD). We conducted a meta-analysis to systematically assess the feasibility, clinical success, and safety of these procedures. Patients and methods We searched Embase, PubMed, and Cochrane Central from inception to October 2020. Overlapping reports, animal studies, and case reports were excluded. Our primary outcomes were clinical success and adverse events (AEs). Secondary outcomes included technical success, endoscopic esophagitis, 24-hour pH monitoring, and proton pump inhibitor (PPI) use. A random effects model was used to pool data. Results In total, 15 nonrandomized studies (12 ARMS, n = 331; 3 ARMA, n = 130) were included; 10 were conducted in patients with refractory GERD. The technical success rate was 100 %. The pooled short-term (first assessment within the first 6 months), 1-year, and 3-year clinical success rates were 78 % (95 % confidence interval [95 %CI] 70 %–85 %), 72% (95 %CI 47 %–92 %), and 73 % (95 %CI 65 %–81 %), respectively. ARMS and ARMA yielded similar clinical success. The proportion of patients off PPIs at 1 year was 64 % (95 %CI 52 %–75 %). There were significant drops (P < 0.01) in validated clinical questionnaires scores, presence of esophagitis, and acid exposure time. The most common AE (11 %, 95 %CI 8 %–15 %) was dysphagia requiring dilation (7%, 95 %CI 5 %–11 %). Four cases of perforation were recorded, all in patients undergoing ARMS. Conclusions Our meta-analysis of nonrandomized studies suggests that ARMS and ARMA are safe and effective for patients with GERD.

Antireflux mucosal intervention (ARMI) procedures for refractory gastroesophageal reflux disease: a systematic review and meta-analysis

“…A strength of this systematic review is the thorough inclusion of up-to-date articles, with critical appraisal and analysis. Although another recent meta-analysis compared ARMS and ARMA, 35 we excluded studies with small sample sizes to reduce bias, and we also explored factors such as postoperative GEJ competency and risk factors for treatment failure in detail. Furthermore, the current analysis was comprehensive as we also included ARBL due to its similarity to ARMS in concept and technique, except that no resection is performed.…”

Minimally invasive endoscopic therapies for gastro-oesophageal reflux disease

“…A 2020 single arm pilot study found significant improvement in DeMeester scores and GERD-HRQL scores among 12 patients 62. A 2021 meta-analysis of non-randomised studies revealed similar levels of efficacy between ARMS and ARMA with acceptable safety profile 63…”

“… 62 A 2021 meta-analysis of non-randomised studies revealed similar levels of efficacy between ARMS and ARMA with acceptable safety profile. 63 …”

Updates on Surgical Treatment for Gastroesophageal Reflux Disease

“…73 Antireflux mucosectomy and antireflux mucosal ablation have gained particular interest because they do not require add-on devices and are not technically difficult to perform. 74 Currently, no long-term RCTs are available to add this procedure to the armamentarium for GERD treatment.…”