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

This study features the dead space—eliminating technique (DET) as a novel closure method during antireflux mucoplasty (ARM-P) for proton pump inhibitor refractory—dependent GERD. Other techniques such as antireflux mucosectomy and antireflux mucosal ablation have shown effectiveness in meta-analyses, but they faced challenges such as slow therapeutic onset and bleeding risk in patients on antithrombotic medications.

To address these concerns, we introduced ARM-P. Nonetheless, our initial pilot study with 20 cases used manual closure methods (Loop-9 and Loop-11), which might pose challenges for less-experienced practitioners.

To overcome this, we applied DET using anchor prong clips, providing a rapid and straightforward alternative. This study showcases a successful case application of DET during ARM-P with anchor prong clips.

Our study demonstrates that successful dead space—free closure in ARM-P leads to favorable clinical outcomes. Anchor prong clips, with their superior tissue-grasping capabilities, ensure secure defect closure. Engineered with anchor prongs for a firm tissue grasp, they facilitate effective tissue apposition through the drag technique.

However, in cases with substantial mucosal defects, using clips on the contralateral mucosa may inadvertently create a dead space, potentially resulting in delayed wound healing. DET emerges as a promising solution to address these challenges, indicating that using anchor prong clips could be a viable option for suturing large mucosal defects.

Recently, the concept of using anchor prong clips to prevent dead space has emerged for endoscopic submucosal dissection defect closure. DET can be used, of course, for closure of ARM-P, as well as other substantial mucosal defects, such as those occurring after endoscopic submucosal dissection.

Simplified illustration demonstrating the dead space–eliminating technique.

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.