Antireflux Mucosectomy (ARMS) for Treatment of Gastroesophageal Reflux

Inclusion Criteria: 1. Patients with typical symptoms of GERD with symptomatic response to PPI therapy for ≥ 3 months 2. Hill's grade II and III of the gastroesophageal junction 3. One of the following abnormalities in the objective assessment 3.1. Excessive acid exposure at the distal esophagus evidenced by 24 hour pH tests using % total time pH \< 4 and / or DeMeester score 3.2. Endoscopic evidence of LA classes A,B,C or D esophagitis 3.3. Defective LES assessed by HRM with resting pressure of \< 6mmHg or total length of less than 4cm or abdominal length of less than 2cm Exclusion Criteria: 1. Age \> 70 yrs of \< 18 yrs 2. Pregnancy 3. Any type of Hiatus hernia 4. Patients with underlying malignancy 5. ASA above grade III