Endoscopic Mucosal ablation safe and effective treatment option for refractory GERD

ARMA is an emerging endoscopic treatment to enhance the gastroesophageal junction flap valve. The main objective of this study was to evaluate its feasibility, effectiveness, and safety.

From May 2018 to December 2022, patients with symptoms of GERD that were refractory to acid suppression medication or dependent on such medications were enrolled in the ARMA. This retrospective analysis used prospectively collected data from an international, bi-center study. The study included GERD questionnaires, upper endoscopies, and 24-hour pH monitoring at 2 to 6 months and 12 months post-ARMA. The clinical success of the treatment was defined as a >50% reduction in validated GERD questionnaire.

Researchers in this study reported the following points:

• Sixty-eight patients underwent ARMA.
• Forty-four patients had definitive GERD, and 24 patients had reflux hypersensitivity.
• At 2–6 months and one-year post-ARMA, clinical success rates were 60% and 70%, respectively.
• There was a significant improvement in the median GERD-health-related quality of life score from 26 to 11 at 2–6 months.
• Among the 51 patients, constituting 71.8%, who underwent 24-hour pH monitoring, there was a decrease in median acid exposure time from 5.3% to 0.7%. A significant reduction in rates of esophagitis accompanied this.
• Multivariate analysis did not identify predictors of short-term success.
• A total of nine patients experienced transient stenosis requiring balloon dilation.

They said that ARMA demonstrated both technical feasibility and reproducibility as a safe procedure in this study. It effectively ameliorates GERD symptoms in two-thirds of patients during short-term follow-up. This procedure is suitable for both reflux hypersensitivity and confirmed GERD patients, regardless of their response to acid suppression medication.

Reference:

Shimamura Y et al. Clinical outcomes of antireflux mucosal ablation for gastroesophageal reflux disease: An international bi-institutional study. J Gastroenterol Hepatol. 2023 Oct 3. doi: 10.1111/jgh.16370. Epub ahead of print. PMID: 37787176.