Post written by Kazuki Yamamoto, MD, PhD, from the Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan.

This study introduces a novel therapeutic approach known as antireflux mucoplasty (ARM-P) to tackle the challenges associated with proton pump inhibitor (PPI)—refractory GERD.

Previously, we pioneered 2 techniques, antireflux mucosectomy (ARMS) and antireflux mucosal ablation (ARMA), which have demonstrated their effectiveness in the management of PPI-refractory GERD, as evidenced by a meta-analysis of nonrandomized controlled studies featuring favorable long-term outcomes.

Nonetheless, ARMS and ARMA have limitations, including a slow onset of therapeutic effect and an increased risk of delayed bleeding in patients taking antithrombotic medications. To address these issues, we propose a potential solution: performing immediate mucosal defect closure following mucosectomy, which is the core concept of our new therapeutic approach, ARM-P.

Our study offers a substantial contribution to the treatment of GERD by showcasing how the ARM-P technique effectively addresses the challenges encountered with ARMS. By promptly closing mucosal defects following mucosectomy, ARM-P has the potential to expedite therapeutic effects and reduce postprocedure bleeding risks.

We believe that this study will capture the attention of endoscopists because of its exploration of an innovative dimension in the realm of endoscopic antireflux therapy for PPI-refractory GERD. In the context of this therapy, ARMS will be expected to be transitioned to ARM-P. Nevertheless, considering its technical simplicity, ARMA will continue to be a robust contender for endoscopic antireflux treatments, alongside ARM-P.

The endoscopic appearance and morphology before antireflux mucoplasty. A, Upper endoscopy revealed no signs of erosive esophagitis. B, The Hill’s flap grade was classified as II.

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