Endoscopic Treatment of GERD: GerdX, ARMA

Introduction: Endoscopic antireflux procedures such as GERDX, MUSE, ARMS, and ARMA are used to treat refractory GERD. GERDX is a novel endoscopic plication device. ARMA is a simple mucosal ablation technique. Presenting 2 cases of refractory GERD, one treated with GERDX and the other with ARMA (anti-reflux mucosal ablation).

Case 1: A 26-year-old female long-standing reflux symptoms dependent on PPI. UGI scopy—Lax LES Hill’s grade II otherwise normal mucosal study. HREM—low basal LES pressures with normal esophageal motility. 24 hour pH impedance study—significant distal esophageal acid exposure percent time >4.2%, DeMeester score 21.1 (normal < 14.3), increased reflux episodes and strong symptom association with reflux episodes. Patient underwent GERDX and no procedure related complications were noted. 2 month postprocedure, patients’ 24 hour pH impedance study showed a decrease in distal esophageal acid exposure, and improvement in basal LES pressure.

Case 2: A 40-year-old male with long-standing reflux symptoms dependent on PPI. UGI scopy showed Lax LES Hills Grade II, otherwise normal mucosal study. HREM showed low basal LES pressures with normal esophageal motility. 24-hour pH impedance study showed DeMeester score 25 (normal < 14.3), increased reflux episodes and strong symptom association with reflux episodes. Patient underwent ARMA procedure. No procedure-related complications noted. 1 month postprocedure, patients’ 24-hour pH impedance study showed a decrease in distal esophageal acid exposure.

Conclusion:: Endoscopic treatment of GERD in selected group of patients is rewarding with less adverse events.

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Publication History

Article published online:
22 April 2024