학술논문

Clinical outcomes of anti-reflux mucosal ablation for gastroesophageal reflux disease: An international bi-institutional study.
Document Type
Academic Journal
Author
Shimamura Y; Digestive Disease Center, Showa University Koto Toyosu Hospital, Tokyo, Japan.; Inoue H; Digestive Disease Center, Showa University Koto Toyosu Hospital, Tokyo, Japan.; Tanabe M; Digestive Disease Center, Showa University Koto Toyosu Hospital, Tokyo, Japan.; Ushikubo K; Digestive Disease Center, Showa University Koto Toyosu Hospital, Tokyo, Japan.; Yamamoto K; Digestive Disease Center, Showa University Koto Toyosu Hospital, Tokyo, Japan.; Kimoto Y; Digestive Disease Center, Showa University Koto Toyosu Hospital, Tokyo, Japan.; Nishikawa Y; Digestive Disease Center, Showa University Koto Toyosu Hospital, Tokyo, Japan.; Ando R; Digestive Disease Center, Showa University Koto Toyosu Hospital, Tokyo, Japan.; Sumi K; Digestive Disease Center, Showa University Koto Toyosu Hospital, Tokyo, Japan.; Navarro MJ; Digestive Disease Center, Showa University Koto Toyosu Hospital, Tokyo, Japan.; Teruel Sanchez-Vegazo C; Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.; Peñas B; Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.; Parejo S; Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.; Martínez Sánchez A; Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.; Vazquez-Sequeiros E; Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.; Onimaru M; Digestive Disease Center, Showa University Koto Toyosu Hospital, Tokyo, Japan.; Albillos A; Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.; Rodriguez de Santiago E; Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
Source
Publisher: Blackwell Scientific Publications Country of Publication: Australia NLM ID: 8607909 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1440-1746 (Electronic) Linking ISSN: 08159319 NLM ISO Abbreviation: J Gastroenterol Hepatol Subsets: MEDLINE
Subject
Language
English
Abstract
Background and Aim: Anti-reflux mucosal ablation (ARMA) is an emerging endoscopic treatment aimed at enhancing the gastroesophageal junction flap valve. This study aimed to evaluate its feasibility, effectiveness, and safety.
Methods: Between May 2018 and December 2022, patients with gastroesophageal reflux disease (GERD) symptoms refractory to acid suppression medications or those dependent on such medications were enrolled for ARMA. This retrospective analysis utilized prospectively collected data from an international bi-center study. GERD questionnaire, upper endoscopy, and 24-h pH monitoring were conducted at 2-6 months and 12 months post-ARMA. Clinical success was defined as a > 50% reduction in a validated GERD questionnaire.
Results: A total of 68 patients underwent ARMA. Definitive GERD was diagnosed in 44 (64.7%) patients, while 24 (35.3%) exhibited reflux hypersensitivity. Clinical success rates at 2-6 months and 1 year post-ARMA were 60% (39/65) and 70% (21/30), respectively. The median GERD-health-related quality of life score significantly improved from 26 to 11 at 2-6 months (P < 0.001). Among the 51 patients (71.8%) who underwent 24-h pH monitoring, the median acid exposure time decreased from 5.3% to 0.7% (P = 0.003), accompanied by a significant reduction in esophagitis rates (P < 0.001). Multivariate analysis did not identify predictors of short-term success. Nine (13.2%) patients experienced transient stenosis requiring balloon dilation.
Conclusions: ARMA demonstrates both technical feasibility and reproducibility as a safe procedure that effectively ameliorates GERD symptoms in approximately two-thirds of patients during short-term follow up. Both reflux hypersensitivity and confirmed GERD patients, regardless of their response to acid suppression medication, may be suitable candidates.
(© 2023 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.)