First Experience with Banded Anti-reflux Mucosectomy (ARMS) for GERD: Feasibility, Safety, and Technique (with Video)

  • Herbert Mason HedbergEmail author
  • Kristine Kuchta
  • Michael B. Ujiki
Multimedia Article



Anti-reflux mucosectomy (ARMS) is a relatively new endoscopic procedure for gastroesophageal reflux disease (GERD). A hemi-circumferential endoscopic mucosal resection (EMR) is performed around the gastroesophageal junction (GEJ), which then contracts and tightens during healing. The aim of this study was to assess the feasibility and safety of the procedure. A secondary aim was to assess short-term outcomes on PPI use and symptom resolution.


IRB approval was obtained for retrospective review of a prospectively collected database including patients who underwent ARMS during a 2-year period. To be eligible for the procedure, patients required medically refractory GERD and a hiatal hernia no more than 2 cm. A 270-degree mucosal resection of the gastric cardia was performed in a retroflexed position using a multi-band EMR system. Demographics, preoperative workup, intraoperative factors, additional procedures, and other follow-up were collected by chart review. Voluntary validated surveys assessed symptomatic improvement over time.


There were 19 patients available for review. The procedure was technically completed in all cases. There was one muscle injury due to a deep resection that was repaired by endoscopic suturing. All patients were discharged on the day of the procedure. Early dysphagia was experienced by three patients (16%) which was addressed with endoscopic balloon dilation. GERD symptoms improved in 13 patients (68%) after discontinuing PPI therapy. Three of the six failures went on to have additional anti-reflux surgery. Among patients who did not have additional surgery, quality of life data showed significant symptomatic improvement by 6 months.


In this ARMS case series, the procedure was technically successful in all patients with only one minor complication. Two thirds of patients showed symptomatic improvement and were able to discontinue their PPI. ARMS appears to be a safe procedure that does not hinder future laparoscopic anti-reflux surgery in case of failure. Additional tuning of technique and postoperative management may be able to reduce dysphagia rates and the need for dilation.


Anti-reflux Mucosectomy Endoscopic Mucosal Resection Banding ARMS EMR 


Compliance with Ethical Standards

Conflict of Interest

Dr. Hedberg and Ms. Kuchta have no conflicts of interest to disclose. Dr. Ujiki receives consulting fees from GORE, Boston Scientific, Apollo Endosurgery, Olympus, and Medtronic, none directly related to the submitted work.


The views expressed in the submitted article are the authors’ own and not an official position of their respective institutions.


  1. 1.
    Gawron AJ, French DD, Pandolfino JE et al. Economic evaluations of gastroesophageal reflux disease medical management. Pharmacoeconomics 2014; 32:745–758.CrossRefPubMedCentralGoogle Scholar
  2. 2.
    Brasseur JG, Ulerich R, Dai Q et al. Pharmacological dissection of the human gastro-oesophageal segment into three sphincteric components. J Physiol 2007; 580: 961–975.CrossRefPubMedCentralGoogle Scholar
  3. 3.
    Menezes MA, Herbella FA. Pathophysiology of gastroesophageal reflux disease. World J Surg 2017; 41: 1661–1671.CrossRefGoogle Scholar
  4. 4.
    Reimer C. Safety of long-term PPI therapy. Best Pract Res Clin Gastroenterol. 2013;27(3):443–54.CrossRefGoogle Scholar
  5. 5.
    Witteman BP, Conchillo JM, Rinsma NF et al. Randomized controlled trial of transoral incisionless fundoplication vs. proton pump inhibi-tors for treatment of gastroesophageal reflux disease. Am J Gastroenterol 2015; 110: 531–542.CrossRefGoogle Scholar
  6. 6.
    Ozawa S, Kumai K, Higuchi K et al. Short-term and long-term outcome of endoluminal gastroplication for the treatment of GERD: the first multicenter trial in Japan. J Gastroenterol 2009; 44: 675–684.CrossRefGoogle Scholar
  7. 7.
    Satodate H, Inoue H, Yoshida T, et al. Circumferential EMR of carcinoma arising in Barrett's esophagus: case report. Gastrointest Endosc. 2003;58:288–292.CrossRefGoogle Scholar
  8. 8.
    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(4):346–351.PubMedCentralGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of Chicago MedicineChicagoUSA
  2. 2.NorthShore University HealthSystem Research InstituteEvanstonUSA
  3. 3.Department of SurgeryNorthShore University HealthSystemEvanstonUSA

Personalised recommendations