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Short and long term effect of anti-reflux mucosectomy with cap-assisted endoscopic mucosal resection for refractory gastroesophageal disease

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Abstract

Background and aims

Anti-reflux mucosectomy with cap-assisted endoscopic mucosal resection (ARMS-C) is a safe and effective treatment for managing refractory gastroesophageal reflux disease (GERD). This study aimed to investigate the short and long-term outcomes of ARMS-C.

Methods

This study was conducted from 2018 to 2022, during which 115 eligible patients underwent ARMS-C. The primary endpoints of this study were to evaluate the GERD-Q questionnaire score and determine the number of patients who reduced their proton pump inhibitor (PPI) dosage or discontinued PPI usage. The secondary endpoints included the evaluation of the DeMeester score, acid exposure time (AET), gastroesophageal flap valve grade (GEFV), lower esophageal sphincter pressure, the rate of successful esophageal peristalsis, and GERD-Q questionnaires. Additionally, we analyzed the long-term efficacy of ARMS-C.

Results

Out of the 120 patients, 115 underwent ARMS-C, 96 were followed up for at least six months after the procedure, and 22 were followed up for at least two years. The primary outcome showed a significant improvement in GERD-Q scores, decreasing from 10.67 to 7.55 (p < 0.001). Out of the 96 patients, 36 were able to reduce or completely stop using PPIs. The DeMeester score, GEFV, AET, and the proportion of intact peristalsis also demonstrated improvement. As for the long-term efficacy of ARMS-C, 86% of patients showed improvement in symptoms, and no serious adverse effects were reported after the procedure.

Conclusion

ARMS-C is a safe and effective endoscopic technique to treat refractory GERD patients.

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Author notes

  1. Yoon Soo Lee and Jee Hyun Kim have equally contributed to this work.

Authors and Affiliations

  1. Department of Gastroenterology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, 13496, Korea

    Yoon Soo Lee, Jee Hyun Kim & In Kyung Yoo

  2. Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Korea

    Dong Keon Yon

  3. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Cha Bundang Medical Center, 59 Yatapro, Bundang-gu, Seongnam-si, Korea

    In Kyung Yoo

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  1. Yoon Soo Lee
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Correspondence to In Kyung Yoo.

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Yoon Soo Lee, Jee Hyun Kim, Dong Keon Yon and In kyung Yoo have no conflicts of interest or financial ties to disclose.

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Lee, Y.S., Kim, J.H., Yon, D.K. et al. Short and long term effect of anti-reflux mucosectomy with cap-assisted endoscopic mucosal resection for refractory gastroesophageal disease. Surg Endosc 38, 2180–2187 (2024). https://doi.org/10.1007/s00464-024-10766-2

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  • DOI: https://doi.org/10.1007/s00464-024-10766-2

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