Ligation‐Assisted Antireflux Mucosectomy on PPI‐Dependent and Cardioesophageal Sphincter Relaxed GERD: 4 Years Results of a Prospective, Multicenter Study (With Video)

Objectives Gastroesophageal reflux disease (GERD) is a prevalent gastrointestinal condition and ligation‐assisted antireflux mucosectomy (ARMS‐L) which is a modified ARMS procedure that combines mucosa ligation and endoscopic mucosectomy was evaluated as an effective and safe endoscopic procedure. Moreover, the long‐term efficacy of ARMS‐L requires further validation. Methods This prospective study included 189 patients with proton pump inhibitor (PPI)‐dependent and cardioesophageal sphincter‐relaxed GERD. Primary endpoint was the treatment efficacy (subjective and objective symptom): the total GERD‐HRQL questionnaire score and the rate of PPI discontinuation at the follow‐up. Secondary endpoints included improvements in GERD‐Q scores, HRM, 24‐h pH impedance monitoring, and AFS grade, as objective measures of hiatal disruption. Results All patients underwent ARMS‐L successfully and the average duration of follow‐up are 48 months. 70.3% (133/189) of patients achieved a ≥ 50% improvement in the total GERD‐HRQL score. HRM parameters improved significantly, with LES resting pressure increasing from 6.3 to 6.6 mmHg and LES residual pressure from 5.9 to 7.2 mmHg. 24‐h pH impedance monitoring showed significant improvement, with the DeMeester score decreasing from 27.23 to 8.63. 70.9% of patients stopped PPIs, and 29.1% used PPIs occasionally. The improvement in the DeMeester score was lower in patients with AFS grade 1 (from 24.13 to 9.74) compared with those with grade 2 (from 27.98 to 7.86) and grade 3 (from 28.86 to 8.90). Conclusions ARMS‐L reduced GERD symptoms and improved the quality of life for a long time, particularly in PPI‐dependent and cardioesophageal sphincter relaxed GERD patients.