Clinical feasibility of a new antireflux ablation therapy on gastroesophageal reflux disease (with video)

Mondragón, Oscar V. Hernández; Mottú, Raúl Antonio Zamarripa; Contreras, Luís Fernando García; Aguilar, Raul Alberto Gutiérrez; Pineda, Omar; Blanco‐Velasco, Gerardo; Pérez, Enrique Murcio

doi:10.1016/j.gie.2020.04.046

Cited by 32 publications

(78 citation statements)

References 38 publications

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“…The post-procedural efficacy has been variably assessed considering a decrease in AET and/or DeMeester (DM) score, GERD-Health Related Quality of Life Questionnaire, GerdQ and Frequency Scale for the Symptoms of GERD, and PPI discontinuation. Even if most studies report significant improvement in the evaluated parameters, they are flawed by many limitations such as lack of multicenter RCTs, small patient samples and short-term evaluations (199)(200)(201)(202)(203).…”

Section: Endoscopic Mucosal Resection Techniquesmentioning

confidence: 99%

Refractory Gastroesophageal Reflux Disease: A Management Update

et al. 2021

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Gastroesophageal reflux disease (GERD) is one of the most frequent gastrointestinal disorders. Proton pump inhibitors (PPIs) are effective in healing lesions and improving symptoms in most cases, although up to 40% of GERD patients do not respond adequately to PPI therapy. Refractory GERD (rGERD) is one of the most challenging problems, given its impact on the quality of life and consumption of health care resources. The definition of rGERD is a controversial topic as it has not been unequivocally established. Indeed, some patients unresponsive to PPIs who experience symptoms potentially related to GERD may not have GERD; in this case the definition could be replaced with “reflux-like PPI-refractory symptoms.” Patients with persistent reflux-like symptoms should undergo a diagnostic workup aimed at finding objective evidence of GERD through endoscopic and pH-impedance investigations. The management strategies regarding rGERD, apart from a careful check of patient's compliance with PPIs, a possible change in the timing of their administration and the choice of a PPI with a different metabolic pathway, include other pharmacologic treatments. These include histamine-2 receptor antagonists (H2RAs), alginates, antacids and mucosal protective agents, potassium competitive acid blockers (PCABs), prokinetics, gamma aminobutyric acid-B (GABA-B) receptor agonists and metabotropic glutamate receptor-5 (mGluR5) antagonists, and pain modulators. If there is no benefit from medical therapy, but there is objective evidence of GERD, invasive antireflux options should be evaluated after having carefully explained the risks and benefits to the patient. The most widely performed invasive antireflux option remains laparoscopic antireflux surgery (LARS), even if other, less invasive, interventions have been suggested in the last few decades, including endoscopic transoral incisionless fundoplication (TIF), magnetic sphincter augmentation (LINX) or radiofrequency therapy (Stretta). Due to the different mechanisms underlying rGERD, the most effective strategy can vary, and it should be tailored to each patient. The aim of this paper is to review the different management options available to successfully deal with rGERD.

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Section: Endoscopic Mucosal Resection Techniquesmentioning

confidence: 99%

Refractory Gastroesophageal Reflux Disease: A Management Update

et al. 2021

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“…In 2020, Inoue et al [ 75 ] and Hernández Mondragón et al [ 76 ] proposed that ablation of the gastric cardiac mucosa by argon plasma coagulation (forced mode 100 W) or a coagulation current applied by an endoknive (spray coagulation 50 W, effect 2) can also induce scar formation and yield similar clinical outcomes. This approach, named anti-reflux mucosal ablation (ARMA), is intended to simplify the procedure, reduce the risk of perforation, and facilitate the retreatment of patients who have failed ARMS.…”

Section: Current Endoscopic Therapiesmentioning

confidence: 99%

“…In addition to their technical simplicity, ARMS and ARMA do not require costly add-on devices and can be performed in a standard endoscopy room[ 72 , 76 ]. Key points during ARMS and ARMA are adequate submucosal injection to prevent perforation and the sparing of a rim of healthy mucosa to minimize the risk of GEJ stenosis .…”

Section: Current Endoscopic Therapiesmentioning

confidence: 99%

“…In total, 15 nonrandomized studies (12 on ARMS[ 69 - 72 , 74 , 77 - 83 ] and three on ARMA[ 75 , 76 , 84 ]) comprising 461 patients have evaluated the safety and effectiveness of these techniques (Tables 1 and 3 ). Follow-up ranged from 2 mo to a maximum of 3 years (in two studies[ 72 , 76 ]). Clinical success ranged from 58% to 100% at 2-6 mo[ 81 , 83 ] and from 72% to 76% at 3 years[ 72 , 76 ].…”

Section: Current Endoscopic Therapiesmentioning

confidence: 99%

“…Follow-up ranged from 2 mo to a maximum of 3 years (in two studies[ 72 , 76 ]). Clinical success ranged from 58% to 100% at 2-6 mo[ 81 , 83 ] and from 72% to 76% at 3 years[ 72 , 76 ]. Dysphagia was the most common adverse event, occurring in about 5% to 10% of the patients.…”

Section: Current Endoscopic Therapiesmentioning

confidence: 99%

See 2 more Smart Citations

Endoscopic anti-reflux therapy for gastroesophageal reflux disease

Santiago¹,

Albéniz²,

Estremera-Arévalo³

et al. 2021

WJG

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Gastroesophageal reflux disease has an increasing incidence and prevalence worldwide. A significant proportion of patients have a suboptimal response to proton pump inhibitors or are unwilling to take lifelong medication due to concerns about long-term adverse effects. Endoscopic anti-reflux therapies offer a minimally invasive option for patients unwilling to undergo surgical treatment or take lifelong medication. The best candidates are those with a good response to proton pump inhibitors and without a significant sliding hiatal hernia. Transoral incisionless fundoplication and nonablative radiofrequency are the techniques with the largest body of evidence and that have been tested in several randomized clinical trials. Band-assisted ligation techniques, anti-reflux mucosectomy, anti-reflux mucosal ablation, and new plication devices have yielded promising results in recent noncontrolled studies. Nonetheless, the role of endoscopic procedures remains controversial due to limited long-term and comparative data, and no consensus exists in current clinical guidelines. This review provides an updated summary focused on the patient selection, technical details, clinical success, and safety of current and future endoscopic anti-reflux techniques.

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Positive and negative impact of anti-reflux mucosal intervention on gastroesophageal reflux disease

Chou

Chen

et al. 2022

Surg Endosc

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Clinical feasibility of a new antireflux ablation therapy on gastroesophageal reflux disease (with video)

Cited by 32 publications

References 38 publications

Refractory Gastroesophageal Reflux Disease: A Management Update

Refractory Gastroesophageal Reflux Disease: A Management Update

Endoscopic anti-reflux therapy for gastroesophageal reflux disease

Positive and negative impact of anti-reflux mucosal intervention on gastroesophageal reflux disease

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