Anti-reflux mucosectomy with band ligation in the treatment of refractory gastroesophageal reflux disease
Abstract
For patients with refractory gastroesophageal reflux disease (rGERD), the American Society for Gastrointestinal Endoscopy recommends surgical treatment such as fundoplication to reduce the diameter of the cardia [1]. Several endoscopic treatments are described using new devices, but they suffer from a lack of feasibility and high costs [2]. Anti-reflux mucosectomy (ARMS) could also narrow the esophagogastric junction (EGJ) as a result of tissue shrinkage induced during cicatrization [3, 4]. We applied this technique using band ligation (ARMS-b) in the management of rGERD. We report the case of a 63-year-old man with a long history of GERD uncontrolled by proton pump inhibitor (PPI) therapy. His main symptom was daily pyrosis, which had a significant impact on his quality of life. The diagnosis was confirmed by pH-impedancemetry and manometry, which eliminated an esophageal motility disorder. ARMS-b was performed in this patient in an ambulatory setting. For the ARMS-b procedure, a Duette Band Ligation device (Cook Medical, Bloomington, Indiana, USA) was mounted onto an endoscope with large operating channel (3.8mm). Adrenaline serum (1/1000) was injected into the submucosa at the EGJ oriented toward the lesser curvature of the stomach. The mucosa was captured with the band ligation device, and piecemeal mucosectomy of three-quarters of the circumference of the EGJ was performed using a hexagonal snare (ERBE VIO2 settings: Endocut Q, effect 2) (▶Fig. 1, ▶Video1). The patient…
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