Abstract：
BACKGROUND: Treatment options for gastroesophageal reflux disease (GERD) that is unresponsive to proton pump inhibitors (PPIs) remain limited. Therefore, we compared the therapeutic effects of anti-reflux mucosectomy (ARMS) and Stretta radiofrequency (SRF) for intractable GERD in over 400 individuals who underwent either procedure.
METHODS: We conducted a retrospective study between 2016 and 2023 to evaluate the effectiveness of SRF and ARMS treatments for refractory GERD. The primary measure of success was the change in the GERD questionnaire (GERDQ) score. The secondary outcomes were various GERD-related indicators, including endoscopic Los Angeles (LA) classification, Hill\'s type-based flap valve grade (FVG), EndoFLIP™ distensibility index (DI), rate of PPI discontinuation, resolution rate of Barrett\'s esophagus, and incidence of adverse events.
RESULTS: The ARMS group included patients with high GERDQ scores, FVG, LA grade, and Barrett\'s esophagus. Both groups had similar rates of improvements in GERDQ score (P = 0.884) and PPI withdrawal (P = 0.866); however, the ARMS group had significantly more side effects and improvements in the median change in GERDQ score (P = 0.011), FVG (P < 0.001), LA grade (P < 0.001), EndoFLIP™ DI (P < 0.001), and resolution of Barrett\'s esophagus (P < 0.001).
CONCLUSIONS: The ARMS group had a greater GERDQ score improvement than the SRF group but had symptom relief and PPI discontinuation rates similar to those of the SRF group. However, objective measures, including EndoFLIP™ DI and endoscopic evaluations, were better in the ARMS group than in the SRF group.
METHODS: We conducted a retrospective study between 2016 and 2023 to evaluate the effectiveness of SRF and ARMS treatments for refractory GERD. The primary measure of success was the change in the GERD questionnaire (GERDQ) score. The secondary outcomes were various GERD-related indicators, including endoscopic Los Angeles (LA) classification, Hill\'s type-based flap valve grade (FVG), EndoFLIP™ distensibility index (DI), rate of PPI discontinuation, resolution rate of Barrett\'s esophagus, and incidence of adverse events.
RESULTS: The ARMS group included patients with high GERDQ scores, FVG, LA grade, and Barrett\'s esophagus. Both groups had similar rates of improvements in GERDQ score (P = 0.884) and PPI withdrawal (P = 0.866); however, the ARMS group had significantly more side effects and improvements in the median change in GERDQ score (P = 0.011), FVG (P < 0.001), LA grade (P < 0.001), EndoFLIP™ DI (P < 0.001), and resolution of Barrett\'s esophagus (P < 0.001).
CONCLUSIONS: The ARMS group had a greater GERDQ score improvement than the SRF group but had symptom relief and PPI discontinuation rates similar to those of the SRF group. However, objective measures, including EndoFLIP™ DI and endoscopic evaluations, were better in the ARMS group than in the SRF group.
摘要：
背景：对质子泵抑制剂（PPI）无反应的胃食管反流病（GERD）的治疗选择仍然有限。因此,我们比较了抗反流粘膜切除术(ARMS)和Stretta射频(SRF)治疗难治性GERD的400余例患者的疗效.
方法：我们在2016年至2023年之间进行了一项回顾性研究，以评估SRF和ARMS治疗难治性GERD的有效性。成功的主要衡量标准是GERD问卷（GERDQ）评分的变化。次要结果是各种GERD相关指标，包括内窥镜洛杉矶（LA）分类，基于希尔类型的瓣阀等级(FVG)，EndoFLIP™膨胀指数(DI),PPI停药率，Barrett食管的分辨率,和不良事件的发生率。
结果：ARMS组包括GERDQ评分高的患者，FVG,洛杉矶等级,还有Barrett的食道.两组在GERDQ评分(P=0.884)和PPI戒断(P=0.866)方面的改善率相似;ARMS组有明显更多的副作用和GERDQ评分中位数变化的改善（P=0.011），FVG（P<0.001），LA等级（P<0.001），EndoFLIP™DI（P<0.001），Barrett食管的分辨率（P<0.001）。
结论：ARMS组比SRF组有更大的GERDQ评分改善，但症状缓解和PPI停药率与SRF组相似。然而,客观措施,包括EndoFLIP™DI和内窥镜评估，ARMS组优于SRF组。
方法：我们在2016年至2023年之间进行了一项回顾性研究，以评估SRF和ARMS治疗难治性GERD的有效性。成功的主要衡量标准是GERD问卷（GERDQ）评分的变化。次要结果是各种GERD相关指标，包括内窥镜洛杉矶（LA）分类，基于希尔类型的瓣阀等级(FVG)，EndoFLIP™膨胀指数(DI),PPI停药率，Barrett食管的分辨率,和不良事件的发生率。
结果：ARMS组包括GERDQ评分高的患者，FVG,洛杉矶等级,还有Barrett的食道.两组在GERDQ评分(P=0.884)和PPI戒断(P=0.866)方面的改善率相似;ARMS组有明显更多的副作用和GERDQ评分中位数变化的改善（P=0.011），FVG（P<0.001），LA等级（P<0.001），EndoFLIP™DI（P<0.001），Barrett食管的分辨率（P<0.001）。
结论：ARMS组比SRF组有更大的GERDQ评分改善，但症状缓解和PPI停药率与SRF组相似。然而,客观措施,包括EndoFLIP™DI和内窥镜评估，ARMS组优于SRF组。
