Efficacy and Safety of Closure‐Focused Anti‐Reflux Mucoplasty Compared With Conventional ARMS : A Propensity Score–Matched Study (With Video)

BACKGROUND: Endoscopic anti-reflux therapies, including anti-reflux mucosectomy (ARMS) and mucosal ablation (ARMA), offer minimally invasive treatment for gastroesophageal reflux disease (GERD) but carry risks of stenosis and delayed bleeding. Closure-focused techniques-anti-reflux mucoplasty (ARM-P) and ARM-P with valve (ARM-P/V)-were developed to reduce these events, yet no comparative evaluation exists. Therefore, we aimed to clarify whether closure-focused techniques reduce adverse events while preserving efficacy. METHODS: Patients undergoing first-time endoscopic anti-reflux therapy at a single-center university hospital between 2012 and 2025 were retrospectively analyzed. Procedures were categorized as conventional (ARMA, ARMS) or closure-focused (ARM-P, ARM-P/V). A 1:1 propensity score-matched cohort was created using preoperative clinical and endoscopic variables. Primary outcomes were adverse events; secondary outcomes were symptom scores, Hill grade, and discontinuation of acid-suppressive therapy. Treatment effects were estimated using average treatment effect on the treated (ATET). RESULTS: Among 251 patients, 94 matched pairs were generated. Adverse events occurred in 5.32% of closure-focused cases versus 25.53% with conventional techniques (p < 0.001). ATET showed a 40.4% reduction in overall adverse events (p = 0.009) and a 30.8% reduction in stenosis (p = 0.018). At 2 months, acid-suppressive medication was discontinued in 45.74% of closure-focused patients and 35.11% of conventional patients (p = 0.266), with comparable symptomatic and anatomical outcomes, but a longer procedure time. CONCLUSION: Closure-focused techniques improve safety without compromising clinical or anatomical outcomes and represent a promising refinement of endoscopic anti-reflux therapy; however, these findings should be validated in prospective comparative studies.