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CC BY 4.0 · Endoscopy 2025; 57(S 01): E909-E910
DOI: 10.1055/a-2663-8344
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Endoscopic suturing with muscular after fundus mucoresection for refractory gastroesophageal reflux disease：a new anti-reflux technique

Shan Wu 
1   Digestive Endoscopic Center, Shanghai Sixth Peopleʼs Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China (Ringgold ID: RIN378725)
,
Meiying Zhu
1   Digestive Endoscopic Center, Shanghai Sixth Peopleʼs Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China (Ringgold ID: RIN378725)
,
Xinjian Wan
1   Digestive Endoscopic Center, Shanghai Sixth Peopleʼs Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China (Ringgold ID: RIN378725)
› Author Affiliations

Supported by: National Natural Science Foundation of China 82200710
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A 63-year-old male with a 20-year history of proton pump inhibitor (PPI)-refractory gastroesophageal reflux disease (GERD) presented with persistent heartburn and regurgitation (GERD-HRQL score 29). High-resolution manometry showed a hypotensive lower esophageal sphincter (LES), and 24-hour pH-impedance monitoring confirmed pathological reflux (DeMeester score: 83.18). The patient underwent endoscopic suturing with muscular after fundus mucoresection (ESFM), a novel hybrid procedure combining endoscopic mucosal resection with fundoplication principles ([Fig. 1]). Following an 8-hour preoperative fasting period, the gastric cardia was endoscopically exposed. Key steps included are as follows: mucosal marking at the gastric cardia (1.5 cm × 2 cm area); submucosal injection and circumferential endoscopic mucosal resection; nylon loop placement with clip-anchored muscular plication; and creation of an anti-reflux valve via suture tightening ([Video 1]). Postoperative recovery was uneventful with a 3-day hospitalization. At 3-month follow-up, the patient reported complete resolution of reflux symptoms without dysphagia (GERD-HRQL 7). Repeat endoscopy demonstrated a well-healed plication fold.

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Fig. 1 Endoscopic suturing with muscular after fundus mucoresection (ESFM) procedure for PPI-refractory GERD. a Preoperative view showing a patulous cardia. b Mucosal resection at the gastric fundus. c Suturing with muscular layer plication. d Postoperative appearance demonstrating successful luminal narrowing.
Endoscopic suturing with muscular after fundus mucoresection (ESFM).Video 1

The ESFM procedure effectively addresses GERD pathophysiology by creating a mechanical barrier through combined mucosal resection and muscular plication while narrowing the lumen at the esophagogastric junction, avoiding the morbidity associated with traditional surgical interventions [1] [2]. This case demonstrates ESFM as a promising minimally invasive alternative for PPI-refractory GERD, successfully merging the safety profile of endoscopic resection with the functional efficacy of fundoplication [3]. Further studies are necessary to validate the long-term clinical outcomes of this innovative technique.

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Conflict of Interest

The authors declare that they have no conflict of interest.

  • References

  • 1 Dent J, Holloway RH, Toouli J. et al. Mechanisms of lower oesophageal sphincter incompetence in patients with symptomatic gastrooesophageal reflux. Gut 1988; 29: 1020-1028
    CrossrefPubMedSearch in Google Scholar
  • 2 Zacherl J, Roy-Shapira A, Bonavina L. et al. Endoscopic anterior fundoplication with the Medigus Ultrasonic Surgical Endostapler (MUSE) for gastroesophageal reflux disease: 6-month results from a multi-center prospective trial. Surg Endosc 2015; 29: 220-229
    CrossrefPubMedSearch in Google Scholar
  • 3 Yoo IK, Ko WJ, Kim HS. et al. Anti-reflux mucosectomy using a cap-assisted endoscopic mucosal resection method for refractory gastroesophageal disease: a prospective feasibility study Epub 2019 May 28. Surg Endosc 2020; 34: 1124-1131
    CrossrefPubMedSearch in Google Scholar

Correspondence

Xinjian Wan, MD, PhD
Digestive Endoscopic Center, Shanghai Sixth Peopleʼs Hospital Affiliated to Shanghai Jiaotong University
No. 600 Yishan Road, Xuhui District
200233 Shanghai
China   

Publication History

Article published online:
20 August 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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  • References

  • 1 Dent J, Holloway RH, Toouli J. et al. Mechanisms of lower oesophageal sphincter incompetence in patients with symptomatic gastrooesophageal reflux. Gut 1988; 29: 1020-1028
    CrossrefPubMedSearch in Google Scholar
  • 2 Zacherl J, Roy-Shapira A, Bonavina L. et al. Endoscopic anterior fundoplication with the Medigus Ultrasonic Surgical Endostapler (MUSE) for gastroesophageal reflux disease: 6-month results from a multi-center prospective trial. Surg Endosc 2015; 29: 220-229
    CrossrefPubMedSearch in Google Scholar
  • 3 Yoo IK, Ko WJ, Kim HS. et al. Anti-reflux mucosectomy using a cap-assisted endoscopic mucosal resection method for refractory gastroesophageal disease: a prospective feasibility study Epub 2019 May 28. Surg Endosc 2020; 34: 1124-1131
    CrossrefPubMedSearch in Google Scholar

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Fig. 1 Endoscopic suturing with muscular after fundus mucoresection (ESFM) procedure for PPI-refractory GERD. a Preoperative view showing a patulous cardia. b Mucosal resection at the gastric fundus. c Suturing with muscular layer plication. d Postoperative appearance demonstrating successful luminal narrowing.