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Anti-reflux mucosectomy using a cap-assisted endoscopic mucosal resection method for refractory gastroesophageal disease: a prospective feasibility study

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Background and aims

Endoscopic therapy of gastroesophageal reflux disease (GERD) overcomes the “treatment gap” for patients with refractory GERD, who are not willing to go into surgery. We propose an easy and efficient technique that is referred to as anti-reflux mucosectomy (ARMS) using cap-assisted endoscopic mucosal resection (EMR-C) which could be called ARMS-C. This study aimed to investigate the short-term outcomes of ARMS-C in GERD patients.


From December 2016 to February 2018, we performed ARMS-C in 33 patients with pathologic reflux disease and esophageal hypersensitivity. ARMS-C involved endoscopic mucosal resection at the circumference of the esophagogastric junction (EGJ), resulting in narrowing of the hiatal opening after healing. The GERD symptoms, 24-h pH monitoring results, manometry, endoscopy, and EGJ distensibility were compared before and after the procedure.


Six months after ARMS-C, 63% of patients discontinued the use of pump inhibitors (PPIs), while 30% patients reduced their PPI dose. The GERD questionnaire scores significantly decreased after ARMS-C, from 11.0 to 6.0 (P < 0.001). The median DeMeester score and acid exposure time based on pH monitoring also improved after ARMS-C. Furthermore, the median flap valve grade and EGJ distensibility decreased from 3.0 to 1.0 (P < 0.001) and from 19.0 to 13.9 (P < 0.001), respectively. Two patients were treated with balloon dilation due to stricture, but no other serious adverse events were encountered.


ARMS-C may be an effective and safe treatment method for GERD in terms of short-term outcomes.

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We thank the Center for Clinical Development (CHA Health Systems) for providing the statistical help.

Author information

WJK, JYC designed the report; HSK, JC, HKK recruited patients; WHK, SPH organized the report; JHK, AÖY reviewed the case and gave critical revision; and IY, WJK wrote the paper.

Correspondence to Joo Young Cho.

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Authors In kyung Yoo, Weon Jin Ko, Hak Su Kim, Hee Kyung Kim, Jung Hyun Kim, Won Hee Kim, Sung Pyo Hong, Abdullah Özgür Yeniova, Joo Young Cho have no conflicts of interest or financial ties to disclose.

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Yoo, I.k., Ko, W.J., Kim, H.S. et al. Anti-reflux mucosectomy using a cap-assisted endoscopic mucosal resection method for refractory gastroesophageal disease: a prospective feasibility study. Surg Endosc 34, 1124–1131 (2020).

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  • Gastroesophageal reflux disease
  • Anti-reflux mucosectomy
  • Short-term outcomes
  • Cap-assisted endoscopic mucosal resection