Antireflux band mucosectomy: a novel minimally invasive approach for the treatment of refractory gastroesophageal reflux disease

Post written by Ameya Deshmukh, DO, from the Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA, and Jose Nieto, DO, from the Borland Groover Clinic, Jacksonville, Florida, USA.

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In this video, we present a case series of 4 patients who underwent a novel endoscopic therapy for the treatment of refractory GERD.

The endoscope was advanced into the stomach of Patient 1 and retroflexed, displaying the cardia and incompetent valve. Band ligation using suction was applied parallel to the angle of His. Hemicircumferential banding allows the esophagogastric junction (EGJ) to constrict appropriately.

A total of 4 bands were used during this case, and the procedure time was 6 minutes. This patient was able to discontinue proton pump inhibitor (PPI) use 2 weeks postprocedure. Repeat EGD and pH bravo test results at 3 months indicated complete acid control postprocedure.

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All 4 patients underwent a decrease in DeMeester score and acid exposure time. The procedure time ranged from 6 to 15 minutes. There were no adverse events. All patients were taken off PPI therapy by 4 weeks postprocedure.

This is a simple, minimally invasive technique using only band ligation, showing promise in the treatment of refractory GERD. Endoscopist training and facility capabilities do not limit the technique, unlike past antireflux mucosectomy (ARMS) approaches that used more-advanced techniques such as endoscopic submucosal dissection and EMR.

Our technique skips the active resection portion seen in previous ARMS procedures. The band constriction causes delayed scarring and fibrosis that further narrow the EGJ. We speculate this procedure variation is faster and safer than ARMS, although additional studies will need to verify this. The antireflux band mucosectomy (ARBM) procedure should be considered in patients who decline surgery and have a hiatal hernia <2 cm, a hill grade ≤2, and an abnormal pH study result with symptomatic reflux.

Dr Nieto performed the ARBM at Borland Groover Clinic Center for Endoscopy.

Deshmukh_Nieto_figureA forward-viewing gastroscope was advanced to the esophagogastric junction, visualizing nonerosive esophagitis.

Read the full article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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