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INITIAL EXPERIENCE WITH ANTI-REFULX MUCOSECTOMY
Herbert M. Hedberg*1, Michael Ujiki2
1Surgery, University of Chicago, Chicago, IL; 2Surgery, NorthShore University HealthSystem, Evanston, IL

Background
Anti-reflux mucosectomy (ARMS) is a relatively new endoscopic procedure for gastroesophageal reflux disease (GERD). Endoscopic mucosal resection is performed to remove the mucosa around the gastroesophageal junction (GEJ), which then contracts and tightens during healing. The aim of this study is to assess the feasibility and safety of the procedure. A secondary aim was to assess short-term outcomes on PPI use and symptom resolution.

Methods
IRB approval was obtained for retrospective review of patients who underwent ARMS by a single surgeon from 2015 to present. To be eligible for the procedure, patients must have medically refractory GERD and a hiatal hernia no more than 2cm. Mucosal resection of the gastric cardia just distal to the GE junction was performed in a 270 degree fashion using banding and hot snare for all procedures. Demographics, preoperative workup, intraoperative factors, additional procedures and other follow-up was collected by chart review.

Results
There were ten patients available for review. The procedure was technically completed in all cases. There was one muscle injury due to a deep resection that was repaired by endoscopic suturing with no sequelae. Two cases were performed with concurrent procedures - one a cholecystectomy, and the other an endoscopic pyloromyotomy. All patients were discharged on the day of the procedure. There were no postoperative complications. Six patients reported significantly improved symptoms and were able to discontinue PPI use. One of these patients had pH testing one year post-procedure which normalized. Four patients had persistent symptoms with reflux confirmed by pH testing, and each had additional uneventful laparoscopic anti-reflux surgery.

Conclusion
In this ARMS case series, the procedure was technically successful in 100% of patients. All patients were able to discharge on the day of procedure. There were no postoperative complications. Six of ten patients were able to discontinue their PPI. ARMS appears to be a safe procedure that does not hinder future laparoscopic antireflux surgery in case of failure.


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