ArticleDigestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society2026
Efficacy and Safety of Closure-Focused Anti-Reflux Mucoplasty Compared With Conventional ARMS: A Propensity Score-Matched Study (With Video).
Article in Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundEndoscopic anti-reflux therapies, including anti-reflux mucosectomy (ARMS) and mucosal ablation (ARMA), offer minimally invasive treatment for gastroesophageal reflux disease (GERD) but carry risks of stenosis and delayed bleeding. Closure-focused techniques-anti-reflux mucoplasty (ARM-P) and ARM-P with valve (ARM-P/V)-were developed to reduce these events, yet no comparative evaluation exists. Therefore, we aimed to clarify whether closure-focused techniques reduce adverse events while preserving efficacy.
methodsPatients undergoing first-time endoscopic anti-reflux therapy at a single-center university hospital between 2012 and 2025 were retrospectively analyzed. Procedures were categorized as conventional (ARMA, ARMS) or closure-focused (ARM-P, ARM-P/V). A 1:1 propensity score-matched cohort was created using preoperative clinical and endoscopic variables. Primary outcomes were adverse events; secondary outcomes were symptom scores, Hill grade, and discontinuation of acid-suppressive therapy. Treatment effects were estimated using average treatment effect on the treated (ATET).
resultsAmong 251 patients, 94 matched pairs were generated. Adverse events occurred in 5.32% of closure-focused cases versus 25.53% with conventional techniques (p < 0.001). ATET showed a 40.4% reduction in overall adverse events (p = 0.009) and a 30.8% reduction in stenosis (p = 0.018). At 2 months, acid-suppressive medication was discontinued in 45.74% of closure-focused patients and 35.11% of conventional patients (p = 0.266), with comparable symptomatic and anatomical outcomes, but a longer procedure time.
conclusionClosure-focused techniques improve safety without compromising clinical or anatomical outcomes and represent a promising refinement of endoscopic anti-reflux therapy; however, these findings should be validated in prospective comparative studies.
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