Endoscopic anti-reflux mucosectomy for refractory gastroesophageal reflux disease in the absence of hiatus hernia / 中华普通外科杂志

ABSTRACT

Objective:To evaluate the efficiency and safety of endoscopic anti-reflux mucosectomy (ARMS) for refractory gastroesophageal reflux disease (rGERD) in the absence of hiatus hernia (HH).Methods:Among 28 rGERD patients adimitted to Gastrointestinal Medical Center, Subei People's Hospital from Jan 2018 to Jun 2020 16 underwent endoscopic mucosal resection (EMR) and 12 did endoscopic submucosal dissection (ESD), The GERD symptoms, endoscopy, 24-h pH monitoring results, manometry, were compared before and after the procedure.Results:ARMS was successfully performed in all 28 patients. Three months after ARMS, 19 patients discontinued the use of pump inhibitors (PPIs), while 9 patients reduced their PPI dose. The GERD questionnaire scores, the median gastroesophageal flap valve grade, the median DeMeester score and acid exposure time based on 24 h esophageal pH monitoring were significantly lower than those before treatment [6.5±2.5 vs.13.4±3.1, 1(1-2) vs.3(1-3), 14.8(8.2-30) vs.34.6(16.2-60.7), 4.4%(1.3%-7.9%) vs. 8.7%(6.2%-13.9%),all P<0.01]. Esophageal sphincter pressure increased after ARMS, from (9.0±3.2) mmHg to (15.5±5.5) mmHg ( t=0.159, P<0.01). The operation time used in ESD was (66.9±4.5) minutes compared to EMR [(29.1±2.0) minutes]( t=13.911, P<0.001). The treatment cost of ESD was (19.9±1.6) thousand yuan vs. for EMR [(9.0±1.6) thousand yuan]( t=58.411, P<0.001). There were no major complications in both groups. Conclusions:ARMS is safe and effective for treatment of rGERD in the absence of HH, and EMR is less time-consuming and more acceptable technique.