Efficacy and Safety of Anti-Reflux Mucosectomy versus Radiofrequency Ablation of the Lower Esophageal Sphincter for the Treatment of Gastroesophageal Reflux Disease: A Systematic Review and Meta-Analysis
Abstract
BACKGROUND AND AIMS
Gastroesophageal reflux disease (GERD) affects 10-30% of the population. Endoscopic anti-reflux therapies have been proposed for carefully selected patients. The aim of this study was to compare outcomes between endoscopic anti-reflux mucosectomy (ARMS) and endoscopic radiofrequency ablation of the lower esophageal sphincter (Stretta procedure) for the treatment of GERD.
METHODS
A systematic review using the Medline database was performed to identify original articles analyzing outcomes after ARMS and Stretta procedures. Main outcomes included patient satisfaction, GERD-HRQL scores, PPI usage, and DeMeester scores. Post-procedural complications were included as secondary outcomes. A meta-analysis of proportions and linear regression models were used to assess the effect of each endoscopic procedure on the different outcomes.
RESULTS
A total of 66 studies comprising 3,767 patients were included; 3,074 (81.60%) underwent Stretta and 693 (18.40%) ARMS. The weighted pooled patient satisfaction was 65% (95% CI, 52%-76%) for ARMS and 77% (95% CI, 64%-87%) for Stretta. Both treatments significantly reduced PPI use (ARMS: from 100% to 40.18% vs. Stretta: from 99.42% to 48.51%, p=0.20) and improved GERD-HRQL scores (ARMS: pre 19.75 to post 8.24 vs. Stretta: pre 21.02 to post 10.45, p=0.70). DeMeester scores improved similarly after both procedures (ARMS: pre 44.99 to post 15.02 vs. Stretta: pre 52.29 to post 28.99, p=0.48). ARMS was associated with higher overall…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 3,767 participants or records.
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