Endoscopic construction of an antireflux mucosal barrier for the treatment of GERD: a pilot study (with video)

Abstract

Background and AimsBased on porcine natural anti-reflux mechanism, we developed a novel endoscopic procedure to build an anti-reflux mucosal flap to block acid reflux and treat gastroesophageal reflux disease (GERD). MethodsThe anti-reflux mucosal valvuloplasty (ARMV) procedure is performed by releasing and reconstructing 3/4 circumference of cardiac mucosa at the lesser curvature side into a double-layer mucosal flap. The mucosal flap works together with cardiac scarring to block reflux. We retrospectively reviewed 30 cases received ARMV from 2019 to 2021. Subjective and objective data evaluating GERD was collected pre- and post-ARMV. ResultsAll 30 ARMV procedures were performed successfully, the mean operation time was 72.6±20.3 min. 1 patient had post-operative bleeding that required endoscopic hemostasis. The mean follow-up time was 28.9±13.9 months. 83.3% (25/30) and 88.5% (23/26) patients reported discontinuation or reduction in proton pump inhibitor (PPI) therapy 3 months and 1 year after ARMV, respectively. GerdQ and GERD-HRQL scores improved significantly from 14.0±2.6 and 48.7±15.0, respectively, before ARMV to 7.7±2.5 and 10.2±5.9, respectively, 12-month post-ARMV (P<0.0001 in both comparisons). 11 patients received 24hr esophageal pH monitoring before and after ARMV. The mean acid exposure time (AET) and DeMeester score dropped from 56.9±23.7 and 167.1±80.1, respectively, before ARMV to 5.5±3.0 and 18.6±11.9, respectively, post-ARMV (P<0.0001 in both comparisons). ConclusionsARMV is a safe, feasible and effective procedure for GERD patients in this pilot study. Further prospective and comparative trials are needed to confirm its role among endoscopic anti-reflux therapies.