Anti-reflux mucosectomy (ARMS) and anti-reflux mucosal ablation (ARMA) were developed as interventions for PPI refractory/dependent GERD. Although ARMS and ARMA are established treatments for PPI-refractory GERD, but reliance on natural healing for ulcer scar formation introduces uncertainty and bleeding risk. To address these issues, we introduced a novel approach called anti-reflux mucoplasty (ARM-P), which involves immediate closure of mucosal defects following mucosectomy. This pilot study aims to evaluate the safety, feasibility, and efficacy of ARM-P.
A retrospective single-center study was conducted using prospectively-collected data spanning from October 2022 to July 2023. Patients with PPI refractory/dependent GERD who underwent ARM-P were included. The study evaluated technical success of ARM-P, pre and post ARM-P GERD-Health Related Quality of Life Questionnaire (GERD-HRQL), GerdQ, and Frequency Scale for the Symptoms of GERD (FSSG) scores, along with PPI discontinuation and endoscopic EGJ morphology.
A total of 20 patients with a median age of 61.5 years underwent the ARM-P procedure. The procedure achieved 100% technical success without adverse events. After ARM-P, 55.0% discontinued PPI usage, and 15.0% reduced PPI dose by half. Median GERD-HRQL score improved from 21 to 6 (P = 0.0026), median GERDQ score improved from 9 to 7 (P = 0.0022), and median FSSG score decreased from 16 to 7 (P = 0.0003). Median Hill’s Classification significantly improved from Grade III to Grade I (P = 0.0001).
This study presents the first pilot report of ARM-P, demonstrating its procedural safety, technical feasibility, and short-term efficacy.

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