A prospective pilot study to assess safety and feasibility of anti reflux mucosectomy for gastroesophageal reflux disease

Crescentic ARMS of the esophagogastric junctional (EGJ) mucosa will be conducted with the now standardized techniques of endoscopic mucosal resection (EMR)/endoscopic submucosal dissection (ESD), of at least 3 cm length (1 cm in the esophagus and 2 cm in the stomach), with the length of mucosal resection at the cardia measured in retroflexion from the gastric side. ARMS was conducted along the side of the lesser curve of the stomach, thus preserving a sharp mucosal valve at gastric cardia.

Results suggest a potential anti-reflux effect of ARMS. The mechanism is presumed to be due to scar formation after healing of the mucosal defect . On the gastric side, this induces narrowing of the gastric cardia opening, while preserving and/or re-creating a robust his angle. We also postulate some remodeling of mucosal flap valve as an effective antireflux mechanism at this anatomical level.

As demonstrated in , after ARMS, the lesser curve of the gastric cardia takes on an almost “mechanically-stitched†appearance. The mucosal flap is rebuilt and looks well-defined. Furthermore, the lesser curve side of the EGJ is shortened with scar formation, and greater curve of EGJ (his angle side) is kept non-scarred and therefore retains its flexibility as a mucosal flap valve. Another major advantage of this procedure is that it requires no proprietary equipment and leaves no artificial prostheses in situ (which could generate a foreign body reaction in the future).

Although possible complications may include perforation or bleeding, the techniques of EMR/ESD used in this procedure have become standardized and popularized. These risks are likely to be minimal in “expert†hands and, even if experienced, can be resolved using standardized endoscopic recovery techniques such as coagulation forceps or clips for bleeding and perforation . Furthermore, piecemeal EMR could be a less time-consuming and acceptable (sole) technique in this procedure, particularly if the specimen involves no dysplasia.