title: Anti-reflux mucosectomy for gastroesophageal reflux disease in the absence of hiatus hernia: a pilot study.
abstract: BACKGROUND
  In our previous case report of circumferential mucosal resection for short-segment Barrett's esophagus with high-grade dysplasia, symptoms of gastro-esophageal reflux disease (GERD) were significantly improved. This observation suggests that anti-reflux mucosectomy (ARMS) could represent an effective anti-reflux procedure, with the advantage that no artificial devices or prostheses would be leftin situ.
  
  
  METHODS
  In this pilot study, 10 patients with treatment-refractory GERD received ARMS, 2 of whom circumferential, and the remaining 8 crescentic.
  
  
  RESULTS
  Key symptoms of GERD improved significantly after ARMS. In the DeMeester score, mean heartburn score decreased from 2.7 to 0.3 (P=0.0011), regurgitation score from 2.5 to 0.3 (P=0.0022), and total score from 5.2 to 0.67 (P=0.0011). At endoscopic examination, the flap valve grade decreased from 3.2 to 1.2 (P=0.0152). In 24-h esophageal pH monitoring the fraction of time at pH <4 improved from 29.1% to 3.1% (P=0.1). Fraction time absorbance more than >0.14 of bile reflux was controlled from 52% to 4% (P=0.05). In 2 cases of total circumferential resection, repeat balloon dilation was necessary to control stenosis. In all cases, proton pump inhibitor prescription could be discontinued with no ill effects.
  
  
  CONCLUSIONS
  This initial case series demonstrated the potential anti-reflux effect of ARMS, with a crescentic mucosal resection appearing adequate. Further longitudinal study of patients without sliding hiatus hernia will be required to establish ARMS as an effective technique to control GERD in this setting.
authors.affiliation: Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan (Haruhiro Inoue, Hiroaki Ito, Haruo Ikeda, Chiaki Sato, Hiroki Sato, P. Chainarong, Nikolas Eleftheriadis).
authors.forename: Haruhiro
authors.initials: H
authors.lastname: Inoue
authors.affiliation: Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan (Haruhiro Inoue, Hiroaki Ito, Haruo Ikeda, Chiaki Sato, Hiroki Sato, P. Chainarong, Nikolas Eleftheriadis).
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Ito
authors.affiliation: Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan (Haruhiro Inoue, Hiroaki Ito, Haruo Ikeda, Chiaki Sato, Hiroki Sato, P. Chainarong, Nikolas Eleftheriadis).
authors.forename: Haruo
authors.initials: H
authors.lastname: Ikeda
authors.affiliation: Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan (Haruhiro Inoue, Hiroaki Ito, Haruo Ikeda, Chiaki Sato, Hiroki Sato, P. Chainarong, Nikolas Eleftheriadis).
authors.forename: Chiaki
authors.initials: C
authors.lastname: Sato
authors.affiliation: Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan (Haruhiro Inoue, Hiroaki Ito, Haruo Ikeda, Chiaki Sato, Hiroki Sato, P. Chainarong, Nikolas Eleftheriadis).
authors.forename: Hiroki
authors.initials: H
authors.lastname: Sato
authors.affiliation: Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan (Haruhiro Inoue, Hiroaki Ito, Haruo Ikeda, Chiaki Sato, Hiroki Sato, P. Chainarong, Nikolas Eleftheriadis).
authors.forename: Chainarong
authors.initials: C
authors.lastname: Phalanusitthepha
authors.affiliation: Department of Gastroenterology, King's College Hospital NHS Foundation Trust, London, UK (Bu'Hussain Hayee).
authors.forename: Bu'Hussain
authors.initials: B
authors.lastname: Hayee
authors.affiliation: Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan (Haruhiro Inoue, Hiroaki Ito, Haruo Ikeda, Chiaki Sato, Hiroki Sato, P. Chainarong, Nikolas Eleftheriadis).
authors.forename: Nikolas
authors.initials: N
authors.lastname: Eleftheriadis
authors.affiliation: Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan (Shin-ei Kudo).
authors.forename: Shin-Ei
authors.initials: SE
authors.lastname: Kudo
keywords: Gastroesophageal reflux disease; anti-reflux mucosectomy; endoscopic treatment