Inoue Haruhiro, Yamamoto Kazuki, Shimamura Yuto, Azuma Daisuke, Ushikubo Kei, Okada Hiroki, Kimoto Yoshiaki, Nishikawa Yohei, Tanaka Ippei, Tanabe Mayo, Onimaru Manabu, Navarro Marc Julius
Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan.
Institute of Digestive and Liver Diseases, St. Luke's Medical Center, Quezon City, Philippines.
Dig Endosc. 2024 Jun;36(6):690-698. doi: 10.1111/den.14711. Epub 2023 Nov 23.
Anti-reflux mucosectomy (ARMS) and anti-reflux mucosal ablation (ARMA) were developed as interventions for proton pump inhibitor (PPI)-refractory/-dependent gastroesophageal reflux disease (GERD). Although ARMS and ARMA are established treatments for PPI-refractory GERD, reliance on natural healing for ulcer scar formation introduces uncertainty and bleeding risk. To address these issues, we introduced a novel approach called anti-reflux mucoplasty (ARM-P), which involves immediate closure of mucosal defects following mucosectomy. This pilot study aims to evaluate the safety, feasibility, and efficacy of ARM-P.
A retrospective single-center study was conducted using prospectively collected data from October 2022 to July 2023. Patients with PPI-refractory/-dependent GERD who underwent ARM-P were included. The study evaluated technical success of ARM-P, before and after ARM-P GERD-Health Related Quality of Life Questionnaire, GerdQ, and Frequency Scale for the Symptoms of GERD scores, along with PPI discontinuation and endoscopic esophagogastric junction morphology.
A total of 20 patients with a median age of 61.5 years underwent the ARM-P procedure. The procedure achieved 100% technical success without adverse events. After ARM-P, 55.0% discontinued PPI usage and 15.0% reduced PPI dose by half. Median GERD-Health Related Quality of Life Questionnaire score improved from 21 to 6 (P = 0.0026), median GerdQ score improved from 9 to 7 (P = 0.0022), and median Frequency Scale for the Symptoms of GERD score decreased from 16 to 7 (P = 0.0003). Median Hill's Classification significantly improved from grade III to grade I (P = 0.0001).
This study presents the first pilot report of ARM-P, demonstrating its procedural safety, technical feasibility, and short-term efficacy.
抗反流黏膜切除术（ARMS）和抗反流黏膜消融术（ARMA）是作为质子泵抑制剂（PPI）难治性/依赖性胃食管反流病（GERD）的干预措施而开发的。尽管ARMS和ARMA是治疗PPI难治性GERD的既定方法，但依靠自然愈合形成溃疡瘢痕存在不确定性和出血风险。为了解决这些问题，我们引入了一种名为抗反流黏膜成形术（ARM-P）的新方法，该方法包括在黏膜切除术后立即封闭黏膜缺损。这项前瞻性研究旨在评估ARM-P的安全性、可行性和有效性。
采用2022年10月至2023年7月前瞻性收集的数据进行回顾性单中心研究。纳入接受ARM-P治疗的PPI难治性/依赖性GERD患者。该研究评估了ARM-P的技术成功率、ARM-P前后的GERD健康相关生活质量问卷、GerdQ和GERD症状频率量表评分，以及PPI停药情况和内镜下食管胃交界形态。
共有20例中位年龄为61.5岁的患者接受了ARM-P手术。该手术取得了100%的技术成功率，且无不良事件发生。ARM-P术后，55.0%的患者停止使用PPI，15.0%的患者将PPI剂量减半。GERD健康相关生活质量问卷评分中位数从21分提高到6分（P = 0.0026），GerdQ评分中位数从9分提高到7分（P = 0.0022），GERD症状频率量表评分中位数从16分降至7分（P = 0.0003）。希尔分级中位数从III级显著改善至I级（P = 0.0001）。
本研究首次报道了ARM-P的前瞻性研究结果，证明了其手术安全性、技术可行性和短期疗效。
