JCM, Vol. 11, Pages 7141: Utilization of Antireflux Mucosectomy and Resection and Plication: A Novel Approach for the Management of Recurrent Gastroesophageal Reflux Disease after Prior Nissen Fundoplication or Transoral Incisionless Fundoplication

Gastroesophageal reflux disease (GERD) is a prevalent digestive disorder affecting nearly 20% of the United States’ population [1,2]. Acid regurgitation and heartburn are common manifestations of GERD; however, diagnosis is usually dependent on a combination of clinical symptoms, objective endoscopy assessment, and pH monitoring. Treatment to avoid long-term complications, such as stricture or erosive gastritis, is imperative. Initial medical therapy entails acid suppression through proton pump inhibitor (PPI) therapy in combination with lifestyle changes [3]. PPIs are an effective first-line treatment for GERD; however, the disease is not eradicated through this therapy. Some patients require continuous maintenance therapy for recurrent symptoms. Long-term PPI use can lead to adverse effects including, but not limited to, osteoporosis, pneumonia, hypomagnesemia, acute kidney injury, dementia, and infections [4,5]. Several anatomical correction techniques have been developed to treat GERD symptoms through the reshaping of the lower esophageal sphincter (LES) [6,7,8,9,10]. Four such techniques are Nissen fundoplication (NF), transoral incisionless fundoplication (TIF), anti-reflux mucosectomy (ARMS), and Resection and Plication (RAP). NF, a procedure in which the gastric fundus is wrapped around the esophagus, is considered the gold standard treatment for GERD [11]. The TIF procedure is a minimally invasive, FDA-approved, endoscopic procedure also utilized to treat chronic GERD. The procedure entails creating a 270-degree esophagogastric wrap to anchor around the esophagus [8,9]. Over a period of a few years, the wrap created during the NF and TIF procedures can become loose, resulting in a recurrence of GERD symptoms [12,13]. ARMS and RAP are procedures that involve endoscopic mucosal resection of about 65% of the gastroesophageal junction circumference [14]. The goal of this procedure is to reduce the diameter of the gastroesophageal junction through scar formation [14]. We hypothesized that the ARMS and RAP procedures could be utilized safely and effectively to treat loose flap valves with a recurrence of GERD symptoms after prior NF and TIF procedures.

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