A novel modified method for treating patients with refractory gastro-esophageal disease and moderate hiatus hernia.

Abstract

Endoscopic anti-reflux mucosectomy (ARMS) is effective for patients with refractory gastroesophageal reflux disease (rGERD) with small hiatus hernia. However, evidence of its applicability on larger lesions is lacking. This study aimed to evaluate the efficiency and safety of ARMS for patients with rGERD with moderate hiatus hernia (3-5 cm) and determine the appropriate resection range (either 2/3 or 3/4 circumference). Thirty-six patients with rGERD with moderate hiatus hernia were enrolled. They were divided into the 2/3 and 3/4 circumferential mucosal resection groups. The patients received modified ARMS. The gastroesophageal reflux disease questionnaire (GERD-Q) and DeMeeter scores, endoscopy, 24-h pH monitoring results, and lower esophageal sphincter (LES) resting pressure were compared pre and post procedure. The therapeutic effects and complications of the two mucosal resection ranges were analyzed. Thirty-six patients were enrolled in this study, all of whom had undergone ARMS operation with at least 6 months of follow-up. In the 2/3 circumferential mucosal resection group, the GERD-Q score, acid exposure time (AET), and DeMeester score improved significantly compared with those before operation (P<0.001). In the 3/4 circumferential mucosal resection group, the GERD-Q score, AET, and DeMeeter score worsened after six months (P<0.001), but there was no difference between the two groups (P>0.05). In both groups, there was no significant improvement in the ratio of esophagitis grade C/D and LES resting pressure after treatment compared with the baseline values (P>0.05) and no postoperative bleeding or perforation. The incidence of postoperative esophageal stenosis in the 2/3 circumferential mucosal resection group was lower than those in the 3/4 circumferential mucosal resection group (P=0.041). Modified ARMS is effective for patients with rGERD with moderate hiatus hernia, but it cannot significantly increase the postoperative resting pressure of LES. The 2/3 circumferential mucosal resection can reduce the incidence of postoperative esophageal stenosis.