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First Experience with Banded Anti-reflux Mucosectomy (ARMS) for GERD: Feasibility, Safety, and Technique (with Video)

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Anti-reflux mucosectomy (ARMS) is a relatively new endoscopic procedure for gastroesophageal reflux disease (GERD). A hemi-circumferential endoscopic mucosal resection (EMR) is performed around the gastroesophageal junction (GEJ), which then contracts and tightens during healing. The aim of this study was to assess the feasibility and safety of the procedure. A secondary aim was to assess short-term outcomes on PPI use and symptom resolution.

Methods

IRB approval was obtained for retrospective review of a prospectively collected database including patients who underwent ARMS during a 2-year period. To be eligible for the procedure, patients required medically refractory GERD and a hiatal hernia no more than 2 cm. A 270-degree mucosal resection of the gastric cardia was performed in a retroflexed position using a multi-band EMR system. Demographics, preoperative workup, intraoperative factors, additional procedures, and other follow-up were collected by chart review. Voluntary validated surveys assessed symptomatic improvement over time.

Results

There were 19 patients available for review. The procedure was technically completed in all cases. There was one muscle injury due to a deep resection that was repaired by endoscopic suturing. All patients were discharged on the day of the procedure. Early dysphagia was experienced by three patients (16%) which was addressed with endoscopic balloon dilation. GERD symptoms improved in 13 patients (68%) after discontinuing PPI therapy. Three of the six failures went on to have additional anti-reflux surgery. Among patients who did not have additional surgery, quality of life data showed significant symptomatic improvement by 6 months.

Conclusion

In this ARMS case series, the procedure was technically successful in all patients with only one minor complication. Two thirds of patients showed symptomatic improvement and were able to discontinue their PPI. ARMS appears to be a safe procedure that does not hinder future laparoscopic anti-reflux surgery in case of failure. Additional tuning of technique and postoperative management may be able to reduce dysphagia rates and the need for dilation.

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Authors and Affiliations

  1. Department of Surgery, University of Chicago Medicine, Chicago, IL, USA

    Herbert Mason Hedberg

  2. NorthShore University HealthSystem Research Institute, Evanston, IL, USA

    Kristine Kuchta

  3. Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA

    Michael B. Ujiki

Authors
  1. Herbert Mason Hedberg
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  2. Kristine Kuchta
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  3. Michael B. Ujiki
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Correspondence to Herbert Mason Hedberg.

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Conflict of Interest

Dr. Hedberg and Ms. Kuchta have no conflicts of interest to disclose. Dr. Ujiki receives consulting fees from GORE, Boston Scientific, Apollo Endosurgery, Olympus, and Medtronic, none directly related to the submitted work.

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Hedberg, H.M., Kuchta, K. & Ujiki, M.B. First Experience with Banded Anti-reflux Mucosectomy (ARMS) for GERD: Feasibility, Safety, and Technique (with Video). J Gastrointest Surg 23, 1274–1278 (2019). https://doi.org/10.1007/s11605-019-04115-1

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  • DOI: https://doi.org/10.1007/s11605-019-04115-1

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