Antireflux Mucosal Ablation vs Fundoplication for Refractory GERD

Overview

This study compared two treatments for patients with gastroesophageal reflux disease (GERD) that did not improve with standard acid-reducing medications. The two treatments were Antireflux Mucosal Ablation (ARMA), a newer endoscopic procedure, and laparoscopic Nissen fundoplication, a well-established surgical procedure. Two hundred patients with refractory GERD were enrolled between January 2023 and December 2024 at two tertiary referral centers in Egypt. One hundred patients underwent modified ARMA, and 100 patients underwent laparoscopic Nissen fundoplication. Treatment was determined by a multidisciplinary team according to a standardized protocol. The study looked at quality of life scores related to GERD, whether patients were able to stop taking proton pump inhibitors (PPIs), and whether their DeMeester scores returned to normal at 12 months. It also examined surgical details, complications, recurrence rates, findings from routine endoscopy at 6 months, and overall treatment success. This was a retrospective study, meaning the researchers reviewed existing medical records rather than assigning patients to treatments. The results may help doctors and patients choose the most appropriate treatment for refractory GERD.

Gastroesophageal reflux disease (GERD) that does not respond to proton pump inhibitor (PPI) therapy remains a significant clinical challenge. Laparoscopic Nissen fundoplication is the established surgical option for refractory GERD, but it carries risks of gas-bloat syndrome, dysphagia, and other complications. Antireflux mucosal ablation (ARMA) has emerged as a less invasive endoscopic alternative, but comparative data with fundoplication are limited. This retrospective comparative cohort study enrolled 200 patients with refractory GERD between January 2023 and December 2024 at two tertiary referral centers in Egypt. One hundred patients underwent modified ARMA, and 100 patients underwent laparoscopic Nissen fundoplication. Treatment allocation was protocol-driven and determined by a multidisciplinary team. Primary outcomes included GERD-Health Related Quality of Life (GERD-HRQL) scores, PPI cessation rates, and DeMeester score normalization at 12 months. Secondary outcomes included operative parameters, complications, recurrence rates, routine re-endoscopy findings at 6 months, and treatment success rates. Between-group differences were assessed using the chi-square test for proportions and the independent samples t-test or Mann-Whitney U test for continuous variables. This study aims to provide comparative evidence on the safety and effectiveness of ARMA versus laparoscopic Nissen fundoplication in patients with refractory GERD, potentially informing clinical decision-making and treatment selection.