Anti-reflux mucosectomy for gastroesophageal reflux disease in the absence of hiatus hernia: A pilot study

Haruhiro Inoue, Hiroaki Ito, Haruo Ikeda, Chiaki Sato, Hiroki Sato, Chainarong Phalanusitthepha, Bu’Hussain Hayee, Nikolas Eleftheriadis, Shin Ei Kudo

研究成果: Article査読

80 被引用数 (Scopus)

抄録

Background In our previous case report of circumferential mucosal resection for short-segment Barrett’s esophagus with high-grade dysplasia, symptoms of gastro-esophageal reflux disease (GERD) were significantly improved. This observation suggests that anti-reflux mucosectomy (ARMS) could represent an effective anti-reflux procedure, with the advantage that no artificial devices or prostheses would be left in situ. Methods In this pilot study, 10 patients with treatment-refractory GERD received ARMS, 2 of whom circumferential, and the remaining 8 crescentic. Results Key symptoms of GERD improved significantly after ARMS. In the DeMeester score, mean heartburn score decreased from 2.7 to 0.3 (P=0.0011), regurgitation score from 2.5 to 0.3 (P=0.0022), and total score from 5.2 to 0.67 (P=0.0011). At endoscopic examination, the flap valve grade decreased from 3.2 to 1.2 (P=0.0152). In 24-h esophageal pH monitoring the fraction of time at pH <4 improved from 29.1% to 3.1% (P=0.1). Fraction time absorbance more than >0.14 of bile reflux was controlled from 52% to 4% (P=0.05). In 2 cases of total circumferential resection, repeat balloon dilation was necessary to control stenosis. In all cases, proton pump inhibitor prescription could be discontinued with no ill effects. Conclusion This initial case series demonstrated the potential anti-reflux effect of ARMS, with a crescentic mucosal resection appearing adequate. Further longitudinal study of patients without sliding hiatus hernia will be required to establish ARMS as an effective technique to control GERD in this setting.

本文言語English
ページ(範囲)346-351
ページ数6
ジャーナルAnnals of Gastroenterology
27
4
出版ステータスPublished - 2014
外部発表はい

ASJC Scopus subject areas

  • 消化器病学

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