Anti-Reflux Mucosal Ablation (ARMA) as a Treatment Modality for Refractory Gastroesophageal Reflux Disease

Background and study aims: Refractory gastroesophageal reflux disease (GERD) is worldwide gastrointestinal problem, affecting quality of life and can predispose to oesophageal cancer. Refractory GERD management had been interlocked between orally taken acid suppressive drugs and surgeries. A midway solution needed to overcome that bridge using various endoscopic modalities which reduce frequency and severity of disease. This study aimed to evaluate efficacy of ARMA as a novel minimally invasive technique in PPI-dependent GERD patients.Patients and methods: 40 patients with PPI-refractory GERD participated in a prospective single-arm interventional trial to assess the effectiveness of ARMA. Endoscopic evaluation, esophageal manometry, impedance-pH monitoring were performed before the intervention. Symptoms assessment by GERDQ score was done pre and two months post ARMA.Results: 47% of patients classified endoscopically with classified as LA class B esophagitis 62.5% had mild gastritis, hiatal hernia type II detected in (55%) of patients. Median GERDQ score significantly improved from 13 (8 – 15) to 6 (4-12) following the procedure, this improvement significantly related to male gender and LA class C esophagitis, Moreover, 28 patients (70%) stopped PPIs within a year. Only 2 patients (5%) had post ARMA stricture responded to endoscopic dilatation.Conclusion: This pilot study showed that ARMA is a minimally invasive, safe, and effective endoscopic modality for refractory GERD.