Gastroesophageal reflux disease (GERD) is defined as symptoms or mucosal damage produced by the abnormal reflux of gastric contents into the esophagus. PPI-resistant GERD without large hiatal hernia is a problematic disease with troublesome and challenging management.

Although many endoscopic treatment of GERD has been proposed and studied within protocols no endoscopic treatment has been currently used in clinical practice. Recently, Antireflux mucosectomy ARMS has been proposed as a minimally invasive, effective endoscopic treatment for PPI-resistant GERD, without large hiatal hernia.

ARMS is based on natural scar formation after healing of the mucosal defect to close the GEJ, and with no need of insertion or implantation of any foreign instruments into the lower esophagus. “Inoue H, Ito H, Ikeda H, Sato C, Sato H, Phalanusitthepha C, Hayee B, Eleftheriadis N, Kudo SE. Anti-reflux mucosectomy for gastroesophageal reflux disease in the absence of hiatus hernia: a pilot study. Ann Gastroenterol 2014;27:346-351.”

Dr. Nikos Eleftheriadis routinely performs ARMS in the endoscopy department under conscious sedation using the piecemeal EMR-C technique. Patients mobilized the same day, began drinking and discharged the next day after ARMS, and gradually increase to soft diet within 7 days.

ARMS has the great advantage of easy performance, low morbidity, hospitalization time and cost and absence of implantable instruments and is a realistic alternative to more invasive surgical fundoplication.