Endoscopy 2019; 51(04): S193-S194
DOI: 10.1055/s-0039-1681743
ESGE Days 2019 ePoster podium presentations
Saturday, April 6, 2019 14:00 – 14:30: GERD ePoster Podium 4
Georg Thieme Verlag KG Stuttgart · New York

ANTI-REFLUX MUCOSECTOMY (ARMS) IN THE TREATMENT OF REFRACTORY GASTRO-ESOPHAGEAL RELFUX (GERD): PILOT STUDY EVALUATING THE FEASIBILITY AND SAFETY

JM Gonzalez
1   Gastroenterology, Hôpital Nord, AP-HM, Aix-Marseille Université, Marseille, France
,
R Irarrazaval
1   Gastroenterology, Hôpital Nord, AP-HM, Aix-Marseille Université, Marseille, France
,
P Basile
1   Gastroenterology, Hôpital Nord, AP-HM, Aix-Marseille Université, Marseille, France
,
JP Le Mouel
1   Gastroenterology, Hôpital Nord, AP-HM, Aix-Marseille Université, Marseille, France
,
M Barthet
1   Gastroenterology, Hôpital Nord, AP-HM, Aix-Marseille Université, Marseille, France
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

There is no validated endoscopic treatment of GERD. Esophageal mucosectomy is a reference technique, and induce a tissular shrinking at the eso-gastric junction (EGJ). Thus, we propose a pilot study to evaluate the feasibility and the safety of the ARMS procedure in refractory GERD, and to document its efficacy (disappearance of the main symptom and RDQ score).

Methods:

This was a monocentric retrospective study of consecutive patients with GERD refractory to PPI's, without motility disorder, treated by ARMS. Patients with esophagitis or a hiatal hernia > 2 cm were excluded. The procedures were performed in ambulatory, with a therapeutic gastroscope, CO2 insufflation, and using the Duette system (Cook Endoscopy, USA). A mucosectomy of the 3/4 of the circumference of the EGJ was performed, extended to both esophageal and gastric sides. The patients received oral PPI for one month and were evaluated every 3 months.

Results:

19 patients were included, aged of 53 years old [32 – 88]. The main symptom was pyrosis in 74% of cases (n = 14), the others being regurgitations, thoracic pain, recurrent cough/sinusitis.

The procedure was feasible in 100% of the cases. There were no acute complications. Six patients (30%) had moderate dysphagia at one month, three of them requiring one single endoscopic dilatation (12 mm).

The follow-up was 6 to 18 months, and five patients were lost on follow-up. Among the 14 other, the efficacy on the main symptom was complete in 57.4% of cases, partial in 7.1% and absent in 35.5% of the cases. A significant decreasing of RDQ was observed after the treatment 41,2 ± 6,7 vs. 20,1 ± 5,1 (p = 0,0026).

Conclusions:

ARMS for treating refractory GERD is simple, feasible and safe, and could be realized in ambulatory. The efficacy rate was 64.5%, but has to be clarified, after a technical standardization of the procedure and rigorous selection of patients.