Our One Year Experience of Anti-Reflux Mucosal Ablation as a Minimally Invasive Treatment for PPI Dependent or Refractory Gastroesophageal Reflux Disease. A Retrospective Study from a High Prevalence Country in the Middle East

Aims The study aimed to find out the safety and efficacy of ARMA in GERD in this part of the world.

Methods All Proton Pump Inhibitor (PPI) dependent or refractory GERD patients who presented to our hospital were recruited. Patients with large hiatal hernia, bariatric surgery and children were excluded.Retrospective analysis of a prospectively maintained data was used. GERDq questionnaire was used for diagnosing and treatment success of the GERD. The same was confirmed with OGD and pH metry tests. Argon Plasma Coagulation (APC) using a standard gastroscope and 70-100 watts voltage with 1.6-1.8 L/min flow rate was used for ablation in a horse-shoe manner in a retroflexed view. About 1cm of gap was kept between the esophageal mucosa and the ablation area on the cardia to prevent stricture. All procedures were performed under moderate sedation and as outpatient cases. Repeat OGD and pH metry tests were performed after 3, 6 and 12 months. Clinical success was defined as a>50% reduction in a validated GERDq questionnaire or daily stoppage of PPI use. Objective success was defined by normalization of Total Acid Exposure time and DeMeester score and no significant esophagitis on OGD.

Results 100 patients with definitive GERD were recruited. 86 patients underwent ARMA. There was 100% technical success rate. Mean procedure time was 36.4±5.8 minutes. Clinical success rates at 3 and 6 and 12 months were 87.20% and 84.88% and 79.06%,respectively. The mean GERD-health-related quality of life score improved from mean of 29.3±3.8 to 13.4±2.1 at 3 -12 months (P<0.01). Median DeMeester score decreased from 21.6 to 4.9 in 88.23% (P=0.003) in 3-12 Months. Multivariate analysis showed Hill’s grade I to II and PPI depend GERD as predictors of success. Adverse events in the form of stricture (5.81%), Severe pain requiring analgesics (9.30%) and Esophageal Mucosal burn injury (2.32%) were seen. All were managed conservatively and endoscopically. 79.06% of the patients were completely off PPI at 12 months compared to 0% pre ARMA procedure(p=0.0.001).

Conclusions ARMA was safe and effective endoscopic modality of treatment for GERD. Majority of the patients who underwent ARMA were off PPI at one year. PPI dependent GERD and Hill’s grade I to II were predictors of success for ARMA. Large prospective randomized studies with long follow up are required to further substantiate these findings.

Haruhiro Inoue, Mayo Tanabe, Yuto Shimamura, Kazuki Yamamoto, Yohei Nishikawa, Kei Ushikubo, Miyuki Iwasaki, Hidenori Tanaka, Ippei Tanaka, Kaori Owada, Satoshi Abiko, Manabu Onimaru, Stefan Seewald, Phase concept: Novel dynamic endoscopic assessment of intramural antireflux mechanisms (with video), Digestive Endoscopy,

Publication History

Article published online:
27 March 2025