Comparative efficacy and safety of three endoscopic minimally invasive techniques for gastroesophageal reflux disease: A retrospective cohort study

Direct comparative studies of multiple techniques remain scarce in the field of endoscopic minimally invasive treatments for gastroesophageal reflux disease (GERD). This study sought to evaluate the efficacy and safety of radiofrequency ablation (RFA), endoscopic band ligation (EBL), and modified anti-reflux mucosectomy (ARMS). A retrospective study analyzed GERD patients who underwent RFA, EBL, or modified ARMS between January 2018 and June 2024, with 3-month and 1-year follow-ups. Subjective outcomes included reflux symptoms (GERD-Q score), quality of life (GERD-HRQL score), proton pump inhibitors (PPIs) usage, and patient satisfaction. Objective outcomes included acid exposure time (AET) and endoscopic findings. Complications were recorded. Among 119 patients, 32 underwent RFA, 51 underwent EBL, and 36 underwent modified ARMS. All groups achieved notable improvements in symptoms, quality of life, and AET ( p < 0.001). EBL was comparable to RFA regarding symptom relief and satisfaction but superior to modified ARMS ( p < 0.05). Uniquely, EBL significantly improved cardia relaxation and erosive esophagitis ( p < 0.001), whereas RFA and modified ARMS showed limited anatomical effects. At 12-month postoperatively, PPI discontinuation rate was highest in EBL (58.8%), followed by RFA (43.8%) and modified ARMS (33.3%). No serious adverse events occurred with EBL, compared to RFA (6.25%) and modified ARMS (5.56%). However, hiatal hernia and grade II cardia laxity negatively impacted EBL efficacy. EBL demonstrates comparable anti-reflux efficacy to RFA and might be superior to modified ARMS in subjective symptomatic outcomes. EBL could significantly narrow the cardia with a favorable safety profile and appears to be a promising endoscopic therapeutic option for GERD. Hiatal hernia and grade II cardia laxity may affect EBL efficacy.