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Positive and negative impact of anti-reflux mucosal intervention on gastroesophageal reflux disease

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Abstract

Background

Anti-reflux mucosal intervention (ARMI), including anti-reflux mucosectomy (ARMS) and anti-reflux mucosal ablation (ARMA), is a promising endoscopic treatment for gastroesophageal reflux disease (GERD). Few studies reported a detailed analysis of the objective reflux parameters.

Methods

Patients with chronic PPI-dependent GERD and receiving ARMI were prospectively enrolled. Comprehensive clinical symptom profiles, endoscopy results, and 24-h multichannel intraluminal impedance-pH (MII-pH) monitoring were collected and analyzed before and 3 months after ARMI.

Results

Twenty-three patients undergoing ARMI (11 ARMS and 12 ARMA) were enrolled. The median (IQR) operative time and post-procedure stays were 50 (46–56) min and 2 (2–2) days without major complications. 73.9% of patients reported subjective global improvement. A significant decrease in the total reflux symptom index score was noted from 12 (5–19) to 8 (4–12) (P = 0.010). The esophageal acid exposure time (AET) significantly decreased from 4.6 (2.8–6.9) to 2.1 (1.1–5.6) (P = 0.013), and the number of acid refluxes and DeMeester score were significantly reduced. Three patients (13%) had increased AET (3.4% to 6.1%, 6.3% to 15.4%, and 3.2% to 5.6%); however, all reported global improvement and two patients could discontinue PPI subjectively. One patient (4.3%) had worsened erosive esophagitis and reflux symptoms. 56.5% of patients stopped PPI.

Conclusions

ARMI is generally effective and safe in PPI-dependent patients. However, possible negative effects of ARMI exist in some patients; further application of MII-pH is necessitated to evaluate the treatment response after ARMI and avoid the detrimental effect of PPI discontinuation.

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Acknowledgements

The authors would like to thank the staff of the Eighth Core Lab in the Department of Medical Research at the National Taiwan University Hospital for their technical support during this study.

Funding

This work received support from National Taiwan University Hospital (Grant Nos. NTUH. 110- 005025, NTUH 111-S0174). Ministry of Science and Technology (Grant Nos. MOST 108-2628-B-002-019, 109-2628-B-002-036, 110-2628-B-002-048).

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Author notes

  1. Chu-Kuang Chou and Chien-Chuan Chen have contributed equally to this article.

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, 60002, Taiwan

    Chu-Kuang Chou

  2. Clinical Trial Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, 60002, Taiwan

    Chu-Kuang Chou

  3. Obesity Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, 60002, Taiwan

    Chu-Kuang Chou

  4. Department of Internal Medicine, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Taipei, 110225, Taiwan

    Chien-Chuan Chen, Chieh-Chang Chen, Wei-Chih Liao, Han-Mo Chiu, Hsiu-Po Wang, Ming-Shiang Wu & Ping-Huei Tseng

  5. Department of Pediatrics, National Taiwan University Children’s Hospital, Taipei, 10041, Taiwan

    Jia-Feng Wu

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Chu-Kuang Chou, Chien-Chuan Chen, Chieh-Chang Chen, Jia-Feng Wu, Wei-Chih Liao, Han-Mo Chiu, Hsiu-Po Wang, Ming-Shiang Wu, and Ping-Huei Tseng have no conflicts of interest or financial ties to disclose.

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Chou, CK., Chen, CC., Chen, CC. et al. Positive and negative impact of anti-reflux mucosal intervention on gastroesophageal reflux disease. Surg Endosc 37, 1060–1069 (2023). https://doi.org/10.1007/s00464-022-09605-z

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