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Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal disorders globally, often leading to chronic symptoms and dependence on proton pump inhibitors (PPIs).
ARMS-L significantly alleviates GERD symptoms and enhances long-term quality of life, especially in PPI-dependent patients with cardioesophageal sphincter relaxation.
Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal disorders globally, often leading to chronic symptoms and dependence on proton pump inhibitors (PPIs). A novel endoscopic technique, ligation-assisted antireflux mucosectomy (ARMS-L)—a modified version of the traditional ARMS procedure that combines mucosal ligation with endoscopic mucosectomy—has shown promising outcomes. This study aimed to determine the long-term safety and efficacy of ARMS-L in patients with PPI-dependent GERD and cardioesophageal sphincter relaxation.
In this prospective clinical study, 189 patients diagnosed with PPI-dependent and cardioesophageal sphincter-relaxed GERD were included. The primary endpoint assessed treatment effectiveness through subjective and objective outcomes: alteration in GERD-Health Related Quality of Life (GERD-HRQL) scores and the rate of PPI discontinuation at follow-up. Secondary endpoints measured improvements in GERD-Q scores, high-resolution manometry, 24-hour pH impedance monitoring, and Hill’s gastroesophageal flap valve (AFS) grade as indicators of hiatal integrity.
All patients successfully underwent the ARMS-L procedure, with an average observation period of 48 months. A significant 70.3% (133/189) of patients attained at least a 50% improvement in their total GERD-HRQL scores. Objective measures illustrated notable physiological improvement:
Moreover, 70.9% of patients completely discontinued PPIs, and 29.1% required them only occasionally. Symptom improvement was consistent across AFS grades, with the most pronounced benefit witnessed in grades 2 and 3, where the DeMeester score dropped from 27.98 to 7.86 and 28.86 to 8.90, respectively.
The ARMS-L technique offers a safe, effective, and durable solution for GERD management, offering long-term symptom relief and better quality of life, especially for PPI-dependent patients with cardioesophageal sphincter relaxation. These findings reinforce the clinical potential of ARMS-L as a minimally invasive alternative to conventional GERD therapies.
United European Gastroenterology Journal
Ligation-Assisted Antireflux Mucosectomy on PPI-Dependent and Cardioesophageal Sphincter Relaxed GERD: 4 Years Results of a Prospective, Multicenter Study (With Video)
Yuhao Zhu et al.
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