528 ANTI-REFLUX ENDOSCOPIC SURGERY: ENDOSCOPIC CARDIOPLASTY USING ENDOSCOPIC MUCOSAL RESECTION MAY EFFECTIVELY TREAT REFRACTORY GASTROESOPHAGEAL REFLUX DISEASE

Abstract

Anti-reflux endoscopic surgery (ARES) is a new efficacious treatment of option for gastroesophageal reflux disease. We propose to define “esophageal remodeling” as the functional restoration of the esophagogastric junction (EGJ) that involves increased lower esophageal sphincter (LES) pressure. ARES is a endoscopic fundoplication technique using endoscopic mucosal resection (EMR) to treat such refractory GERD patients. This study investigated the clinical outcomes of ARES for refractory GERD patients. ARES was performed in 106 patients with drug-refractory GERD from December 2015 to July 2017. We analyzed data from a prospectively collected database of ARES subjects, which included preprocedure and 6-month postprocedure of GERD-Q symptom scores, and results from esophageal high resolution manometry (HRM) and 24-h pH monitoring. Symptom control rates were compared according to clinical and surgical factors to identify predictive factors of successful surgical outcomes. ARES was performed for 106 patients (55% male; mean age 46.8 years) with PPI-refractory GERD. Mean PPI medication periods were 5.7 (1-30) years and median ARES procedure time was 32.6 (15-83) minutes. The GERD-Q score and 24hr pH monitoring were significantly improved after ARES. Mean post-treatment GERD-Q score was 7.54±2.6, compared to 10.87±2.7 pre-treatment (p<0.001). In impedance planimetry, the mean distensibility was 16.1±8.3 prior to and 9.1±5.7, respectively (p<0.001). No serious complications after ARES were occured. But 6 patients undergo post-treatment stricture, and were treated using balloon dilation and steroid injection. 3 patients suffered from minor post ARES bleeding, successfully treated with argon plasma coagulation. ARES is a very effective and safe treatment option for PPI-refractory GERD patients. ARES can be a good alternative treatment for refractory GERD.