Anti-Reflux Mucosal Ablation (Arma) for Gastroesophageal Reflux Disease: a Feasibility Case Series

Aims Antireflux ablation of the cardiac mucosa (ARMA) is a new endoscopic technique for the gastroesophageal reflux disease (GERD). Our aims were to analyze the feasibility, effectiveness and safety of this technique in patients with PPI-dependent GERD.

Methods We conducted a prospective, single-center case series, from November 2019 to November 2020, of all consecutive patients with PPI-dependent GERD ( > 6 months on PPI and good symptomatic response to PPI) treated with ARMA. The procedure was performed in the left-supine position under proprofol-based sedation. The cardiac mucosa (from the Z line up to 3 cm distally) was marked in a butterfly shape, sparing 1 cm of healthy mucosa in the greater and lesser curvatures. Voluven with indigo carmine (0.02 %) and adrenaline (1: 100.000) was injected into the submucosa and the marked region ablated with a T-T Knife (Olympus©, Spray Coag 50 W, effect 2) or argon plasma coagulation (APC, Forced coagulation,100W, effect 3). Technical success was defined as the complete ablation of the marked area. Clinical success was defined as a decrease >50 % in GERD-HRQL score.

Results 4 procedures were successfully performed on 4 patients (3 with T-T knife, 1 APC). Baseline characteristics are shown in [Tab. 1]. Median procedure time was 59 minutes (range:51-90). Three patients (75 %) achieved clinical success at 4-6 months and were able to discontinue PPI. Median GERD-HRQL decreased from 34 (range:8-36) to 6(range:0-23). Two adverse events were recorded: 1 delayed bleeding (moderate) and 1 patient with intermittent solid dysphagia that required 13.5 mm balloon dilatation.

Conclusions ARMA is feasible and may be effective in a selected population of patients with GERD. Dysphagia and bleeding are the most common adverse events.

Tab. 1

Gender (M:F)	3:1
Median Age, years (range)	24.5 (23-34)
Median time of GERD, years (range)	6 (3-16)
Median baseline acid exposure time off PPI (range)	10.8 % (5.3-18.6)

Citation: Marcos Carrasco N, Rodriguez de Santiago E, Teruel Sanchez-Vegazo C et al. eP43 ANTI-REFLUX MUCOSAL ABLATION (ARMA) FOR GASTROESOPHAGEAL REFLUX DISEASE: A FEASIBILITY CASE SERIES. Endoscopy 2021; 53: S111.

Publication History

Article published online:
19 March 2021