Antireflux Mucosectomy (Arms) and Antireflux Mucosal Ablation (Arma) for the Treatment of Gastroesophageal Reflux Disease: a Systematic Review and Meta-Analysis

Aims 1. To systematically assess the clinical success, safety and 24-h pH-metry outcomes of ARMS and ARMA in patients with GERD. 2. To compare ARMS and ARMA.

Methods We performed a systematic search of Embase, PubMed and Cochrane Central from inception to November 2020. Overlapping reports and case reports were excluded. Our primary outcomes were clinical success (author´s definition or nº of patients off PPI when a definition was not provided) and adverse events. We used a random-effects model to pool and compare data.

Results A total of 14 observational studies (12 ARMS, n = 331; 2 ARMA, n = 120) were included, 10 of them performed in patients with GERD defined as refractory to proton pump inhibitors (PPIs). Technical success was 100 % (95 % CI 100 - 100 %). The short-term clinical success (first assessment within the first 6 months) and at 1 year were 78 % (95 % CI 70 - 85 %, I² 55.5 %) and 72 % (95 % CI 47 - 92 %, I² 93 %), respectively. The rate of adverse events was 12 % (95 % CI 9 - 16 %). Pooled rates of dysphagia requiring dilation and clinically significant bleeding were 8 % (95 %CI 5 - 11 %, I² 0 %) and 0 % (95 % CI, 0 - 1 %, I² 0 %); respectively. Four cases of perforation were recorded, all in patients undergoing ARMS. There was a significant drop in acid exposure time within the first 6 months after the procedure (Mean difference 9.8 %, 95 %CI 1.9 - 17.7 %, I² 84 %). The proportion of patients off PPI at 1 year was 64 % (95 %CI 52 - 75 %, I² 68.8 %). In a subgroup analysis, clinical success was higher in patients treated with ARMA with a similar proportion of adverse events.

Tab. 1

Technique	Clinical success ≤ 6 months (14 studies, n = 424 patients)	Clinical success 1 year (3 studies, n = 212)	Adverse events (13 studies, n = 433)
ARMS	76 % (95 %CI 69-82 %)	61 % (95 %CI 52 - 70 %)	11 % (95 %CI 8 - 16 %)
ARMA	88 % (95 %CI 81-94 %)	89 % (95 %CI 81 - 95 %)	15 % (95 %CI 9 - 22 %)
P value	0.01	< 0.01	0.58

Conclusions This meta-analysis based on non-randomized studies supports that ARMA and ARMS are safe and effective for patients with GERD. Randomized studies with long-term follow up are warranted.

Citation: Rodriguez de Santiago E, Teruel Sanchez-Vegazo C, Marcos Carrasco N et al. eP42 ANTIREFLUX MUCOSECTOMY (ARMS) AND ANTIREFLUX MUCOSAL ABLATION (ARMA) FOR THE TREATMENT OF GASTROESOPHAGEAL REFLUX DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS. Endoscopy 2021; 53: S110.

Publication History

Article published online:
19 March 2021