Anti-reflux mucosal ablation (ARMA) as a novel minimally invasive treatment for severe gastroesophageal reflux disease in a child: the first pediatric case report.

Background: Antireflux mucosal ablation (ARMA) is a novel, minimally invasive endoscopic technique for the treatment of gastroesophageal reflux disease (GERD). Our case report evaluates the feasibility and early clinical outcomes of ARMA in a neurologically impaired pediatric patient with refractory GERD. Case description: A 9-year-old boy with spastic cerebral palsy presented with severe GERD refractory to a long-term proton pump inhibitor therapy. He suffered from profound oropharyngeal dysphagia and recurrent aspiration pneumonia requiring multiple hospitalization. An endoscopic ARMA procedure was performed under general anesthesia without intra-procedural complications or immediate adverse events. Early follow-up revealed improved reflux control, enhanced tolerance of gastrostomy feeding, and a reduced need for acid-suppressive therapy. No respiratory deterioration or procedure-related complications were observed. Conclusions: ARMA is a technically feasible, minimally invasive option for refractory GERD. While this initial case involved a high-risk, neurologically impaired child, the mechanism suggests broader applicability to other pediatric patients with medication-resistant GERD.