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

To our knowledge, this study reports the first instance of antireflux mucosectomy (ARMS) successfully treating GERD after laparoscopic sleeve gastrectomy (LSG). Although LSG is the most common bariatric procedure, accounting for up to 60% of global cases, it also is an independent risk factor for GERD, despite obesity being a known contributor. Nissen fundoplication is an effective laparoscopic surgery used to treat GERD.

However, additional surgery can be invasive for patients, with a generally high level of difficulty. Our previous development of ARMS and antireflux mucosal ablation has shown promise in treating proton pump inhibitor (PPI)—refractory GERD, with good long-term outcomes.

Approximately 35% of patients experience GERD after LSG. Our study demonstrates that the ARMS technique holds promise in effectively managing GERD in patients who have undergone gastric surgery, with minimal invasiveness.

In addition, our findings highlight the effectiveness of ARMS in treating GERD after LSG, even in cases involving large sliding hernias, which are typically managed with surgical fundoplication.

In conclusion, ARMS may be an effective treatment option for patients with PPI-refractory or PPI-dependent GERD and those with GERD who are challenging to treat, such as patients who have undergone gastric surgery.

Upper endoscopy images before antireflux mucosectomy from a patient who had undergone laparoscopic sleeve gastrectomy, depicting grade C erosive esophagitis per the Los Angeles classification system.

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