Post written by Wasseem Skef, MD, from the Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA, and Jasmine Haydel, MD, from the Department of Medicine, Baylor College of Medicine. 

We performed a hybrid endoscopic procedure of antireflux mucosal ablation and fundoplasty using endoscopic suturing for a patient with recurrent GERD after failed fundoplication without significant axial hernia (<2 cm).

Although transoral incisionless fundoplication after failed fundoplication is feasible, safe, and effective in this setting, it may be unavailable or technically infeasible because of anatomic restrictions. We believe our technique may be a viable alternative.

Endoscopic options for revision of failed fundoplication with minimal axial hernia are possible. With newer technologies (ie, single-channel endoscopic suturing with enhanced retroflexion capabilities), we expect further innovations in endoscopic antireflux therapy in the future.

Thank you for the opportunity to present our case.

A, Post-EMR stricture. B, Gastroesophageal junction with Los Angeles Classification grade B esophagitis. C, Narrow-band imaging demonstrating small island of Barrett’s recurrence. D, Preintervention loose fundoplication seen on surveillance endoscopy (Hill grade III). E, Schematic of planned endoscopic intervention. Yellow triangles represent the ablation zone, and the blue diamonds represent locations at which sutures were to be placed. F, Hybrid antireflux mucosal ablation (ARMA) + endoscopic full-thickness fundoplasty (EFTF). G, Post-ARMA + EFTF. H, Follow-up EGD (Hill grade II). I, Ambulatory pH post-ARMA + EFTF: normalization of esophageal acid exposure.

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.