The efficacy of antireflux mucosectomy (ARMS) and antireflux mucosal ablation (ARMA) for gastroesophageal reflux disease (GERD) by 24-h pH monitoring: systematic review and meta-analysis.
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BACKGROUND: Gastroesophageal reflux disease (GERD) is a prevalent and chronic disorder impacting a significant proportion of the global population, approximately 15%. Most GERD patients show improvement with medical treatment, including proton pump inhibitors (PPIs); however, around 40% continue to experience symptoms despite ongoing PPI use. Antireflux mucosal ablation (ARMA) and antireflux mucosectomy (ARMS) are minimally invasive endoscopic procedures for treating GERD. OBJECTIVE: This meta-analysis aimed to evaluate the efficacy of ARMA and ARMS through the DeMeester score, acid exposure time (AET), and clinical success rate. METHODS: Studies reporting pre- and postprocedure esophageal 24 h pH monitoring following ARMA and ARMS were included. Pooled data analysis assessed changes in the DeMeester score and AET using the standardized mean difference (SMD). Clinical success rate, defined as significant symptom improvement or reduced reliance on PPIs, was also analyzed. RESULTS: Pooled data from three ARMA studies showed a significant postprocedure decrease in median AET (SMD: - 20.74, 95% CI [- 25.51, - 15.97], p < 0.0001). Similarly, six ARMS studies demonstrated a significant reduction in DeMeester score (SMD: - 2.79, 95% CI [- 4.33, - 1.26], p < 0.0001). The overall clinical success rate for ARMS was 78%, while ARMA achieved 87%. CONCLUSIONS: Both ARMA and ARMS displayed promising efficacy in improving GERD-related outcomes based on reductions in AET and DeMeester scores and achieving high clinical success rates. However, the high heterogeneity observed suggests further research is needed to identify patient-specific factors influencing treatment response.