Tanabe M., Abad M.R.A., Iwaya Y., et al. A novel endoscopic fundoplication for gastroesophageal reflux disease: anti-reflux mucosal ablation (ARMA). P1976. UEG Journal, 2019, V.7(8S) iv. Abstract issue, p.986.
A novel endoscopic fundoplication for gastroesophageal reflux disease: anti-reflux mucosal ablation (ARMA)
Tanabe M., Abad M.R.A., Iwaya Y., Fujiyoshi Y., Quarta Colosso B.M., Nishikawa Y., Ueno A., Shimamura Y., Sumi K., Tomida H., Ikeda H., Onimaru M., Inoue H.
Contact E-Mail Address: mayo.tanabe (a) gmail.com
Introduction: As a treatment for gastroesophageal reflux disease (GERD), proton pump inhibitors (PPIs) are the mainstay of medical therapy. However, up to 40% of patients are reported to have persistent GERD symptoms despite PPI therapy. Several endoscopic procedures have been attempted but no procedure has been widely accepted as the standard endoscopic treatment for GERD. We developed Anti-reflux mucosal ablation (ARMA) as a minimally invasive treatment.
Aims & Methods: The aim of this study is to clarify the efficacy and safety of ARMA. The indication of ARMA is PPI refractory GERD patient without prominent sliding hernia. The purpose of ARMA is to narrow the space of hiatus hernia by performing ablation to the mucosa at the gastric cardia. Step 1: marking of scheduled ablation area on the mucosa. Mucosal ablation is scheduled along the gastric cardia in butterfly shape to avoid stenosis. Markings on the mucosa were placed using Triangle Tip Knife J connected to the electrocautery generator (VIO300D ERBE) in soft coagulation mode, 50 W, effect1.
Step 2: Saline with indigo carmine dye was injected into submucosa along the markings using 25-Gauge needle. Correct submucosal saline injection was confirmed by lifting of the mucosal surface.
Step 3: Near circumferential (butterfly shape) mucosal ablation was made using Triangle Tip Knife J in spray coagulation mode, 50W, effect2.
The efficacy of ARMA was evaluated using the objective findings (flap valve grade: Ⅰ/Ⅱ/Ⅲ/Ⅳ as point 0/1/2/3, 24-hour multi-channel intraluminal impedance-pH monitoring) and subjective findings (Frequent Scale for the Symptoms of GERD:FSSG, and GERD-HRQL).
Results: A total of 12 patients with median age of 54.5 (29-75), Female 5: Male 7, with PPI-refractory GERD were enrolled in this study between May 2018 and March 2019. The procedure time was 40.3 (20-69) minutes without any immediate complications. GERD-HRQL score improved significantly from median of 30.5 to 12 (p=0.0005), and the FSSG was significantly improved from median of 25 to 10.5 (p=0.0078) both at 2-month follow-up. The Hill’s flap valve grade score significantly improved from 1.91 to 0.5 (p< 0.001). The DeMeester composite score improved from 33.5 to 2.8 (p=0.0547) and percent time clearance pH improved from 9 to 0.5 (p=0.0781) after ARMA. ARMA was successful in all cases and mild stenosis was observed in one patient which was managed by balloon dilatation, and no bleeding nor perforation were observed.
Conclusion: This case series suggests that endoscopic anti-reflux mucosal ablation (ARMA) may represent an effective anti-reflux procedure safely, with the added advantage of simplicity, low cost, less invasive, and leaving no artificial prostheses in situ. Larger studies with long-term follow up are warranted to confirm this result.
Disclosure: Nothing to disclose
Данная публикация — тезисы доклада (abstract) на 27-й Объединённой Европейской Гастроэнтерологической Неделе UEG Week 2019, г. Барселона.
Тезисы (abstracts) всех докладов UEG Week 2019 (pdf, 12,4 Mb): https://www.ueg.eu/publications/abstractbook
См. также: Параскевова А.В. Объединённая Европейская Гастроэнтерологическая Неделя 2019 (United European Gastroenterological Week 2019) // www.gastroscan.ru, 2019.
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