Clinical Utility of Anti‐reflux Mucosal Intervention for Refractory Gastroesophageal Reflux Disease in Patients With a Hiatal Hernia

Background Surgical fundoplication is the standard treatment for refractory gastroesophageal reflux disease (GERD) with large (≥3 cm) hiatal hernias; however, its invasiveness is problematic in older adults and high‐risk patients. Anti‐reflux mucosal intervention (ARMI) is a less invasive endoscopic alternative; however, patients with large hernias have previously been excluded from studies, limiting available evidence. We assessed the feasibility, short‐term clinical outcomes, and safety of ARMI in this population. Methods We retrospectively analyzed consecutive patients with proton pump inhibitor (PPI)/potassium‐competitive acid blocker (P‐CAB)‐refractory GERD and sliding hiatal hernias ≥3 cm who underwent ARMI (anti‐reflux mucosectomy; anti‐reflux mucoplasty) between April 2024 and April 2025. GERD‐Health‐Related Quality of Life (GERD‐HRQL), GERD Questionnaire (GerdQ), and Frequency Scale for the Symptoms of GERD (FSSG) scores were compared before ARMI and 3 months afterward. PPI/P‐CAB discontinuation and treatment‐related adverse events were also assessed. Results Ten patients (mean age 74.3 years; 80% women; hernia size 3–6 cm) were included, all with American Society of Anesthesiologists physical status ≥ II. At 3 months, mean GERD‐HRQL scores decreased from 21.1 to 4.6 ( p = 0.002), FSSG from 22.6 to 6.2 ( p = 0.004), and GerdQ from 10.9 to 4.6 ( p = 0.008). PPI/P‐CAB was discontinued in seven patients. No clinically significant treatment‐related adverse events, including perforation, delayed bleeding, or dysphagia, occurred. Conclusions ARMI was technically feasible, showed favorable short‐term outcomes in patients with refractory GERD and 3–6‐cm hiatal hernias, and may represent a less invasive option for older or high‐risk patients. Trial Registration N/A.