Antireflux mucosectomy (ARMS) and antireflux mucosal ablation (ARMA) for gastroesophageal reflux disease: a systematic review and meta-analysis

Background and study aims Antireflux mucosectomy (ARMS) and antireflux mucosal ablation (ARMA) are new endoscopic procedures for patients with gastroesophageal reflux disease (GERD). We conducted a meta-analysis to systematically assess the feasibility, clinical success, and safety of these procedur...

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Autores principales:	Enrique Rodríguez de Santiago, Carlos Teruel Sanchez-Vegazo, Beatriz Peñas, Yuto Shimamura, Mayo Tanabe, Noelia Álvarez-Díaz, Sofía Parejo, Sumi Kazuya, Natalia Marcos-Carrasco, Enrique Vazquez-Sequeiros, Haruhiro Inoue, Agustín Albillos
Formato:	article
Lenguaje:	EN
Publicado:	Georg Thieme Verlag KG 2021
Materias:	Diseases of the digestive system. Gastroenterology RC799-869
Acceso en línea:	https://doaj.org/article/e024538cc6cd469e9aab00284bc30862
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spelling	oai:doaj.org-article:e024538cc6cd469e9aab00284bc308622021-11-13T00:00:31ZAntireflux mucosectomy (ARMS) and antireflux mucosal ablation (ARMA) for gastroesophageal reflux disease: a systematic review and meta-analysis2364-37222196-973610.1055/a-1552-3239https://doaj.org/article/e024538cc6cd469e9aab00284bc308622021-11-01T00:00:00Zhttp://www.thieme-connect.de/DOI/DOI?10.1055/a-1552-3239https://doaj.org/toc/2364-3722https://doaj.org/toc/2196-9736Background and study aims Antireflux mucosectomy (ARMS) and antireflux mucosal ablation (ARMA) are new endoscopic procedures for patients with gastroesophageal reflux disease (GERD). We conducted a meta-analysis to systematically assess the feasibility, clinical success, and safety of these procedures. Patients and methods We searched Embase, PubMed, and Cochrane Central from inception to October 2020. Overlapping reports, animal studies, and case reports were excluded. Our primary outcomes were clinical success and adverse events (AEs). Secondary outcomes included technical success, endoscopic esophagitis, 24-hour pH monitoring, and proton pump inhibitor (PPI) use. A random effects model was used to pool data. Results In total, 15 nonrandomized studies (12 ARMS, n = 331; 3 ARMA, n = 130) were included; 10 were conducted in patients with refractory GERD. The technical success rate was 100 %. The pooled short-term (first assessment within the first 6 months), 1-year, and 3-year clinical success rates were 78 % (95 % confidence interval [95 %CI] 70 %–85 %), 72% (95 %CI 47 %–92 %), and 73 % (95 %CI 65 %–81 %), respectively. ARMS and ARMA yielded similar clinical success. The proportion of patients off PPIs at 1 year was 64 % (95 %CI 52 %–75 %). There were significant drops (P < 0.01) in validated clinical questionnaires scores, presence of esophagitis, and acid exposure time. The most common AE (11 %, 95 %CI 8 %–15 %) was dysphagia requiring dilation (7%, 95 %CI 5 %–11 %). Four cases of perforation were recorded, all in patients undergoing ARMS. Conclusions Our meta-analysis of nonrandomized studies suggests that ARMS and ARMA are safe and effective for patients with GERD.Enrique Rodríguez de SantiagoCarlos Teruel Sanchez-VegazoBeatriz PeñasYuto ShimamuraMayo TanabeNoelia Álvarez-DíazSofía ParejoSumi KazuyaNatalia Marcos-CarrascoEnrique Vazquez-SequeirosHaruhiro InoueAgustín AlbillosGeorg Thieme Verlag KGarticleDiseases of the digestive system. GastroenterologyRC799-869ENEndoscopy International Open, Vol 09, Iss 11, Pp E1740-E1751 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Diseases of the digestive system. Gastroenterology RC799-869
spellingShingle	Diseases of the digestive system. Gastroenterology RC799-869 Enrique Rodríguez de Santiago Carlos Teruel Sanchez-Vegazo Beatriz Peñas Yuto Shimamura Mayo Tanabe Noelia Álvarez-Díaz Sofía Parejo Sumi Kazuya Natalia Marcos-Carrasco Enrique Vazquez-Sequeiros Haruhiro Inoue Agustín Albillos Antireflux mucosectomy (ARMS) and antireflux mucosal ablation (ARMA) for gastroesophageal reflux disease: a systematic review and meta-analysis
description	Background and study aims Antireflux mucosectomy (ARMS) and antireflux mucosal ablation (ARMA) are new endoscopic procedures for patients with gastroesophageal reflux disease (GERD). We conducted a meta-analysis to systematically assess the feasibility, clinical success, and safety of these procedures. Patients and methods We searched Embase, PubMed, and Cochrane Central from inception to October 2020. Overlapping reports, animal studies, and case reports were excluded. Our primary outcomes were clinical success and adverse events (AEs). Secondary outcomes included technical success, endoscopic esophagitis, 24-hour pH monitoring, and proton pump inhibitor (PPI) use. A random effects model was used to pool data. Results In total, 15 nonrandomized studies (12 ARMS, n = 331; 3 ARMA, n = 130) were included; 10 were conducted in patients with refractory GERD. The technical success rate was 100 %. The pooled short-term (first assessment within the first 6 months), 1-year, and 3-year clinical success rates were 78 % (95 % confidence interval [95 %CI] 70 %–85 %), 72% (95 %CI 47 %–92 %), and 73 % (95 %CI 65 %–81 %), respectively. ARMS and ARMA yielded similar clinical success. The proportion of patients off PPIs at 1 year was 64 % (95 %CI 52 %–75 %). There were significant drops (P < 0.01) in validated clinical questionnaires scores, presence of esophagitis, and acid exposure time. The most common AE (11 %, 95 %CI 8 %–15 %) was dysphagia requiring dilation (7%, 95 %CI 5 %–11 %). Four cases of perforation were recorded, all in patients undergoing ARMS. Conclusions Our meta-analysis of nonrandomized studies suggests that ARMS and ARMA are safe and effective for patients with GERD.
format	article
author	Enrique Rodríguez de Santiago Carlos Teruel Sanchez-Vegazo Beatriz Peñas Yuto Shimamura Mayo Tanabe Noelia Álvarez-Díaz Sofía Parejo Sumi Kazuya Natalia Marcos-Carrasco Enrique Vazquez-Sequeiros Haruhiro Inoue Agustín Albillos
author_facet	Enrique Rodríguez de Santiago Carlos Teruel Sanchez-Vegazo Beatriz Peñas Yuto Shimamura Mayo Tanabe Noelia Álvarez-Díaz Sofía Parejo Sumi Kazuya Natalia Marcos-Carrasco Enrique Vazquez-Sequeiros Haruhiro Inoue Agustín Albillos
author_sort	Enrique Rodríguez de Santiago
title	Antireflux mucosectomy (ARMS) and antireflux mucosal ablation (ARMA) for gastroesophageal reflux disease: a systematic review and meta-analysis
title_short	Antireflux mucosectomy (ARMS) and antireflux mucosal ablation (ARMA) for gastroesophageal reflux disease: a systematic review and meta-analysis
title_full	Antireflux mucosectomy (ARMS) and antireflux mucosal ablation (ARMA) for gastroesophageal reflux disease: a systematic review and meta-analysis
title_fullStr	Antireflux mucosectomy (ARMS) and antireflux mucosal ablation (ARMA) for gastroesophageal reflux disease: a systematic review and meta-analysis
title_full_unstemmed	Antireflux mucosectomy (ARMS) and antireflux mucosal ablation (ARMA) for gastroesophageal reflux disease: a systematic review and meta-analysis
title_sort	antireflux mucosectomy (arms) and antireflux mucosal ablation (arma) for gastroesophageal reflux disease: a systematic review and meta-analysis
publisher	Georg Thieme Verlag KG
publishDate	2021
url	https://doaj.org/article/e024538cc6cd469e9aab00284bc30862
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Antireflux mucosectomy (ARMS) and antireflux mucosal ablation (ARMA) for gastroesophageal reflux disease: a systematic review and meta-analysis

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