Comparison of 180° anti-reflux mucosectomy versus 270° anti-reflux mucosectomy for treatment of refractory gastroesophageal reflux disease: a retrospective study

Background Anti-reflux mucosectomy (ARMS) is a novel endoscopic treatment for refractory gastroesophageal reflux disease (rGERD). Several studies have validated its safety and effectiveness, but postoperative dysphagia remains in concern. Since the influence of different resection ranges on efficacy and complications of ARMS has rarely been studied, this study aimed to compare outcomes of 180 degrees ARMS and 270 degrees ARMS in treatment of rGERD. Methods This study was conducted from August 2017 to September 2020. 39 eligible patients underwent either 180 degrees ARMS or 270 degrees ARMS and followed up at 6 months postoperation. Primary outcome measure was assessed by Gastroesophageal Reflux Disease Questionnaire (GERD-Q). Secondary outcomes included quality of life, PPI use, gastroesophageal flap valve grade, presence of reflux esophagitis, acid exposure time (AET), distal contractile integral (DCI), and integrated relaxation pressure (IRP) measured by high-resolution manometry (HRM) and complication rate. Per-protocol analysis was performed. Results Among 39 patients, 18 underwent 180 degrees ARMS, while 21 underwent 270 degrees ARMS. At postoperative 6 months follow-up period, primary outcome showed no significant difference between two groups (p = 0.34). Similarly, no significant difference was demonstrated between groups regarding most secondary outcomes except for fewer complaints of newly dysphagia in 180 degrees ARMS group. No other serious complications were observed in both groups. Conclusion Although 180 degrees ARMS and 270 degrees ARMS could be equally effective for treatment of rGERD, 180 degrees ARMS might be more recommended due to lower incidence of newly post-procedural dysphagia.

Automated summary

This study compared the outcomes of 180 degrees ARMS and 270 degrees ARMS in treating rGERD, with no significant difference in primary and most secondary outcome measures between the two groups, except for fewer complaints of newly dysphagia in the 180 degrees ARMS group. No other serious complications were observed in both groups.