Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan.
Dig Endosc. 2024 Mar;36(3):305-313. doi: 10.1111/den.14617. Epub 2023 Jul 13.
Minimally invasive treatments have been applied for gastroesophageal reflux disease (GERD), but the long-term results are controversial. Antireflux mucosectomy (ARMS) is a simple endoscopic procedure that does not require the insertion of a foreign body. We provide the first report on the long-term results of ARMS.
This was a single-center, single-arm trial, prospective study of 88 patients with proton pump inhibitor (PPI)-refractory GERD who underwent ARMS between June 2012 and June 2017. Primary outcomes were the rates of long-term effectiveness and PPI discontinuation. Secondary outcomes were to compare patients' preoperative background characteristics, questionnaire, and multichannel intraluminal impedance and pH monitoring data to examine the predictive factors of ARMS. The clinical course was reviewed, including the need for additional treatment after ARMS.
Antireflux mucosectomy produced a long-term effect in 68.3% of the patients, and PPI could be discontinued in 42% of patients. There were significant differences in age, intensity of preoperative symptoms, and acid-related indicators. Forty-five percent (27/60) had reflux hypersensitivity and ARMS provided long-term effectiveness in 81% of these patients. There was no significant difference in subjective symptom assessment between those with short-term and long-term efficacy. Additional treatment was administered in 23% (14/60) and scheduled at 1-2 years' follow-up.
Antireflux mucosectomy showed long-term efficacy, and many of the cases with short-term effects were able to maintain them. In addition, ARMS is also effective in patients with reflux hypersensitivity, and provides a treatment option that bridges the gap between surgical and medical treatment.
微创治疗已应用于胃食管反流病（GERD），但其长期疗效仍存在争议。抗反流黏膜切除术（ARMS）是一种简单的内镜手术，无需插入异物。我们首次报告了 ARMS 的长期疗效。
这是一项单中心、单臂试验，前瞻性研究了 88 例质子泵抑制剂（PPI）难治性 GERD 患者，他们于 2012 年 6 月至 2017 年 6 月期间接受了 ARMS。主要结局是长期疗效和 PPI 停药率。次要结局是比较患者术前背景特征、问卷调查以及多通道腔内阻抗和 pH 监测数据，以检查 ARMS 的预测因素。回顾临床过程，包括 ARMS 后是否需要额外治疗。
ARMS 在 68.3%的患者中产生了长期疗效，42%的患者可以停用 PPI。年龄、术前症状强度和酸相关指标存在显著差异。45%（27/60）存在反流过度敏感，ARMS 对这些患者中的 81%提供了长期疗效。短期和长期疗效患者的主观症状评估无显著差异。23%（14/60）的患者需要额外治疗，并在 1-2 年的随访时进行了安排。
抗反流黏膜切除术显示出长期疗效，且许多短期疗效患者能够维持疗效。此外，ARMS 对反流过度敏感患者也有效，为手术和药物治疗之间提供了一种治疗选择。
