Antireflux Mucosectomy: A new treatment for Refractory GERD in Mongolia

Aims Antireflux mucosectomy (ARMS) and antireflux mucosal ablation (ARMA) are emerging endoscopic treatments for gastroesophageal reflux disease (GERD). GERD affects 28.9% of the Mongolian population, with significant risks including Barrett’s esophagus and esophageal cancer. While proton pump inhibitors (PPIs) are the standard treatment, 10-40% of patients fail to respond, and laparoscopic antireflux surgery (LARS) is the main alternative. In 2014, Inoue et al. first reported successful ARMS outcomes.

Methods This study involved 23 patients with refractory GERD undergoing ARMS at the esophagogastric junction using standard ESD techniques. Symptom improvement was assessed via the GERD-Q questionnaire, and flap valve changes were measured using the Hill classification.

Results A total of 23 patients (Age 50.6, M:F 11:12) underwent ARMS. Key symptoms of GERD improved significantly after ARMS. In the GERD-Questionnaire mean score decreased from 11.9 to 6.6 (P=0.000). The flap valve grade, assessed during follow up endoscopic examination, decreased from 3.1 to 0.8 (P=0.000). 3 case experienced a complication, ARMS related adverse events was esophageal stricture, in which the clinical manifestation was dysphagia. The patients were successfully treated by endoscopic balloon dilationand mean balloon dilation time were 2. (15mm).

Conclusions Several minimally invasive endoscopic techniques have been developed in recent years to fill the existing gap between PPIs and surgery. ARMS and, more recently, ARMA, have gained increasing attention among endoscopists due to their simplicity and both techniques can be performed in an ambulatory setting.

In this study ARMS for GERD with hiatal hernia showed excellent short term result. Future, larger studies with objective assessment and long follow up are warranted. ARMS is a safe and effective procedure for treatment of refractory GERD with high rates of clinical response, acceptable safety profile and significant improvement in GERD-related quality of life. Prospective studies are needed to validate our findings.

Publication History

Article published online:
27 March 2025