Advancing Safety in Endoscopic Anti-Reflux Therapy: Clinical Outcomes of Anti-Reflux Mucoplasty (ARM-P) and Mucoplasty with Valve (ARM-P/V)

Background and Aims
Endoscopic anti–reflux therapies (EARTh), such as anti–reflux mucosectomy (ARMS) and anti–reflux mucosal ablation (ARMA), have demonstrated efficacy for GERD in systematic reviews and meta–analyses. However, these procedures carry risks of delayed bleeding (–5%) and strictures (7–13%) due to variations in individual healing. To enhance safety, we developed Anti–reflux Mucoplasty (ARM–P) and Anti–reflux Mucoplasty with Valve (ARM–P/V). ARM–P refines ARMS by incorporating immediate closure of the resection site, while ARM–P/V uses endoscopic submucosal dissection (ESD) to create a mucosal valve. This study evaluates the impact of these closure techniques on EARTh safety.
Methods
We retrospectively analyzed patients who underwent ARM–P or ARM–P/V for PPI–refractory or PPI–dependent GERD at our hospital (December 2022–August 2024). Follow–up data (1–3 months) included adverse events (delayed bleeding, dysphagia requiring dilation), GERD symptom severity, and quality of life (GERD–HRQL, GerdQ, FSSG). PPI discontinuation rates were also assessed.
Results
Among 63 patients (mean age: 53.1 years), 71.4% (45/63) reduced or discontinued PPI use. GERD–HRQL improved from 21.7 to 11.7 (P < 0.001), GerdQ from 9.1 to 6.9 (P < 0.001), and FSSG from 24.3 to 13.4 (P < 0.001). No cases of delayed bleeding or dysphagia requiring dilation were reported.
Conclusions
Closure techniques in EARTh improve safety, particularly for patients on antiplatelet/anticoagulant therapy or steroids, making ARM–P and ARM–P/V viable treatment options.