356 Mucosal Ablation and Suturing at the Esophagogastric Junction (MASE): A Novel Procedure for the Management of Gastroesophageal Reflux Disease in Altered Anatomy Patients

Abstract

INTRODUCTION: Gastroesophageal reflux disease (GERD) is caused by reflux of gastric contents into the esophagus. For patients with esophageal or gastric surgery there are limited options for endoscopic or surgical therapy for GERD. There has recently been introduced an endoscopic suturing platform that allows for full thickness suturing. We created a technique called Mucosal Ablation and Suturing at the Esophagogastric Junction (MASE) to anatomically correct the GEJ in patients where other surgical or endoscopic options may not be possible. METHODS: This is a single-center prospective observational study. The standardized procedure involved APC ablation below the GE junction to improve tissue apposition prior to suturing. Three sutures were placed along the lesser curvature of the cardia immediately below the EGJ. This creates a tightening and tissue bulge that acts as a barrier to reflux. The primary outcome evaluated was 30% improvement in reflux disease questionnaire (RDQ) and GERD Health Related Quality of Life Questionnaire. The secondary outcomes evaluated were reduction in PPI use, procedure tolerance and safety. RESULTS: 10 patients with a mean age of 63 years with altered anatomy: Fundoplication (N = 5), Billroth II (N = 1), Roux-en-Y (N = 3), and Sleeve gastrectomy (N = 1) underwent MASE procedure. The RDQ and HRQL questionnaires were recorded for each patient before and after MASE. Mean follow-up time was 113 days. Primary outcome of 30% improvement in RDQ and GERD HRQL were achieved for all patients (Figure 1). There was a 90 % reduction in PPI use in the study group; 6 patients (66%) were able to discontinue PPI use, and 2 patients (22%) reduced their dose. The most common side effect was self-limited post-procedure epigastric pain (9%). CONCLUSION: The MASE procedure represents a novel endoscopic treatment option for management of GERD in patients with altered anatomy. Altered anatomy patients have limited treatment options once they fail standard PPI therapy. The MASE procedure can reduce GERD symptoms in this difficult to treat patient population and reduce reliance of daily anti-secretory medication use. Further studies need to be performed to determine longevity of this procedure.