Case Series of Endoscopic Anti-Reflux Mucoplasty Using the Reopenable-Clip Over-the-Line Method for Patients with Proton Pump Inhibitor-Refractory Gastro-Oesophageal Reflux Disease

Aims Endoscopic anti-reflux mucosectomy (ARMS) was developed as a treatment for gastro-oesophageal reflux disease (GERD) that is resistant to or dependent on proton pump inhibitors (PPIs). The enhanced technique, endoscopic anti-reflux mucoplasty (ARMP), aims to address ARMS’s limitations, specifically the “uncertainty of spontaneous ulcer scar contraction” and “risk of post-procedural bleeding.” However, ARMP requires ulcer closure at the gastric cardia, making it technically challenging. The reopenable-clip over-the-line method (ROLM) has been reported as an ulcer closure technique following endoscopic submucosal dissection, using endoscopic clips and nylon thread; it is relatively simple, effective, and does not require specialised equipment. Therefore, our institution has adopted ARMP using ROLM (ARMP-R).

Methods This single-centre retrospective case series includes PPI-resistant GERD patients who underwent ARMP-R between January 2024 and October 2024. The procedures were performed by an experienced endoscopist who, at the initiation of ARMP-R, had no prior experience with ARMS or ROLM. We evaluated technical success rate, procedure time, incidence of adverse events, pre- and post-procedural GERD-related quality of life (GERD-HRQL) scores, GerdQ scores, frequency scale for the symptoms of GERD (FSSG) scores, and endoscopic findings at the oesophagogastric junction.

Results Six patients (median age 54.5, 83% male) underwent ARMP-R, achieving a 100% technical success rate with a median procedure time of 63 minutes, and no adverse events occurred. Post-ARMP, GERD-HRQL scores improved from a median of 30.5 to 14.5, GerdQ scores from 10 to 3, and FSSG scores from 15 to 8.5. Additionally, endoscopic findings showed an improvement in the cardiac opening, reducing from 2 cm to 1 cm.

Conclusions ARMP-R appears to be a feasible and effective approach for the treatment of PPI-resistant GERD.

 

MissingLinkText

Conflicts of Interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
27 March 2025