Outcomes of Endoscopic Anti-Reflux Mucoplasty (ARMP) for Refractory GERD: Ulcer Closure Using the Reopenable-Clip Over-the-Line Method

Background: Endoscopic anti-reflux mucoplasty (ARMP) has been proposed as a method to overcome the limitations of anti-reflux mucosectomy (e.g., delayed bleeding, unpredictability of ulcer scar contraction) by facilitating ulcer closure. However, the closure of the cardia ulcer in ARMP is technically demanding. We hypothesized that the Reopenable-Clip Over-the-Line Method (ROLM), which utilizes clips and nylon sutures, would enable relatively simple ulcer closure. This study reports the outcomes of ARMP using ROLM (ARMP-R). Methods: Patients with refractory GERD who underwent ARMP-R between January 2024 and February 2025 were included. The procedure was performed by an endoscopist without prior experience in ARMS or ROLM. The ARMP-R procedure involved performing multiple sessions of endoscopic aspiration mucosectomy (EAM) to resect the mucosa just below the squamocolumnar junction, and complete ulcer closure using ROLM. Results: Nine patients underwent ARMP-R (median age: 55 years, male: 89%, median BMI: 24.1). The technical success rate was 100%, and the median procedure time was 61 minutes (34 minutes for ROLM). No adverse events were observed. Symptom score medians at baseline and 3 months post-procedure were GERD-HRQL: 30 to 7, GerdQ: 11 to 3, and FSSG: 23 to 6. Additionally, the median CO-SH scale improved from CO: 2.0 cm to 1.1 cm and SH: 1.0 cm to 0 cm. Conclusion: ARMP-R appears to be a relatively short, safe, and effective endoscopic treatment for refractory GERD.