A Pilot Study on Anti‐reflux Mucoplasty: Advancing Endoscopic Anti‐reflux Therapy for Gastro‐esophageal Reflux Disease

Background and Aims: Anti‐reflux mucosectomy (ARMS) and anti‐reflux mucosal ablation (ARMA) were developed as interventions for PPI refractory/dependent GERD. Although ARMS and ARMA are established treatments for PPI‐refractory GERD, but reliance on natural healing for ulcer scar formation introduces uncertainty and bleeding risk. To address these issues, we introduced a novel approach called anti‐reflux mucoplasty (ARM‐P), which involves immediate closure of mucosal defects following mucosectomy. This pilot study aims to evaluate the safety, feasibility, and efficacy of ARM‐P. Methods: A retrospective single‐center study was conducted using prospectively‐collected data spanning from October 2022 to July 2023. Patients with PPI refractory/dependent GERD who underwent ARM‐P were included. The study evaluated technical success of ARM‐P, pre and post ARM‐P GERD‐Health Related Quality of Life Questionnaire (GERD‐HRQL), GerdQ, and Frequency Scale for the Symptoms of GERD (FSSG) scores, along with PPI discontinuation and endoscopic EGJ morphology. Results: A total of 20 patients with a median age of 61.5 years underwent the ARM‐P procedure. The procedure achieved 100% technical success without adverse events. After ARM‐P, 55.0% discontinued PPI usage, and 15.0% reduced PPI dose by half. Median GERD‐HRQL score improved from 21 to 6 ( P = 0.0026), median GERDQ score improved from 9 to 7 ( P = 0.0022), and median FSSG score decreased from 16 to 7 ( P = 0.0003). Median Hill's Classification significantly improved from Grade III to Grade I ( P = 0.0001). Conclusions: This study presents the first pilot report of ARM‐P, demonstrating its procedural safety, technical feasibility, and short‐term efficacy.