Sreevidya B. Pillai, MBBS, MD1, Roy j. Mukkada, MBBS, MD, DNB, MNAMS, FRCP2, Abraham Koshy, DM3 1VPS Lakeshore Hospital, Cochin, Kerala, India; 2VPS Lakeshore Hospital & Research Centre, Cochin, Kerala, India; 3VPS Lakeshore Hospital & Research Centre, Cochin, FL, India
Introduction: GERD is a common disorder with an increasing prevalence.The prevalence of GERD in India ranges from 7.6% to 30 % .Approximately 40% of patients have persistent GERD symptoms despite of PPI therapy.Less invasive antireflux endoscopic interventions are highly desired .ARMA -Antireflux mucosal ablation is a new treatment modality which is minimally invasive but with excellent result in PPI refractory GERD.
Case Description/Methods: 32 year old male patient presented with Reflux symptoms refractory to PPI which increased in last 6 months.Upper GI endoscopy done showing Hiatus Hernia Hills grade III.HRM done was normal.24 hr Ph metery done showing Demeester score of 30.24 & Total reflux time Ph< 4= 7.4%.ARMA done in this patient.He was kept NPO 6 hr pre ARMA.Procedure was done in propofol based sedation. In fully inflated stomach marking placed using TT knife J connected to electrocautory generator.Saline with indigocarmine injected into submucosal layer. Mucosal ablation done using TT knife preserving 1 scope diameter at greater curvature ,1 scope distance away from squamocolumnar junction & ablating a horse shoe shaped region with width of 1.5 scope diameter.Post procedure single dose PPI given for 1 month. Post procedure patient had both excellent symptomatic improvement.Repeat endoscopy done after 2 months showed significant improvement.
Discussion: ARMA is a promising new endoscopic method for PPI refractory GERD.It can be ideally done in patients with (a) presence of atleast one typical reflux symptom more than two times a week despite double dose PPI for atleast 6 months (b) pathological acid exposure defined by Demeester score >14.7 or acid exposure time >4.2%.Ideally patients with primary esophageal motility disorder, sliding hiatal hernia >3 cm, pregnancy to be avoided. ARMA is less invasive endoscopic modality which require less hospital stay.
Figure: Endoscopic appearence pre and 2 months post ARMA
Disclosures: Sreevidya Pillai indicated no relevant financial relationships. Roy Mukkada indicated no relevant financial relationships. Abraham Koshy indicated no relevant financial relationships.
Sreevidya B. Pillai, MBBS, MD1, Roy j. Mukkada, MBBS, MD, DNB, MNAMS, FRCP2, Abraham Koshy, DM3. P1728 - ARMA - A Rosy Approach for PPI Refractory GERD, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.