Antireflux Mucosectomy Band (ARM-b) in Treatment of Refractory Gastroesophageal Reflux Disease After Bariatric Surgery
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Antireflux Mucosectomy Band (ARM-b) in Treatment of Refractory Gastroesophageal Reflux Disease After Bariatric Surgery Antoine Debourdeau 1,2,3
&
Véronique Vitton 2 & Laurent Monino 2,4 & Marc Barthet 2 & Jean-Michel Gonzalez 2
Received: 23 March 2020 / Revised: 24 May 2020 / Accepted: 28 May 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Laparoscopic sleeve gastrectomy has become the most commonly used bariatric surgery worldwide. However, there are a proportion of patients who present with a refractory GERD after this procedure. In these patients, when surgical conversion to RYGPB is not possible or declined, we propose to describe the results of an endoscopic antireflux mucosectomy band (ARM-b) technique in 6 LSG patients with refractory GERD. The technical feasibility was 100%; 5 out of 6 patients had a clinical response with a reduction of the GERD-HRQL score of > 50%. Two patients had adverse events: one esophageal stricture and one benign bleeding. ARM-b is feasible and potentially effective to treat patients with refractory GERD after LSG. Keywords Laparoscopic sleeve gastrectomy . Sleeve . GERD . Reflux . Gastroesophageal reflux disease . Bariatric surgery . ARM . ARMS . ARMb . ARM-b . Antireflux mucosectomy band . Antireflux mucosectomy band ablation . Antireflux mucosectomy ablation . Mucosectomy . EMR . Endoscopy . PPI-refractory GERD . Refractory GERD . GERDQ . GERD-HRQL
Introduction Gastroesophageal reflux disease (GERD) is a frequent and challenging adverse event, particularly in patients who * Antoine Debourdeau [email protected] Véronique Vitton [email protected] Laurent Monino [email protected] Marc Barthet [email protected] Jean-Michel Gonzalez [email protected] 1
Gastroenterology and Liver Transplantation Unit HGEA, CHU Montpellier, Montpellier Université, Montpellier, France
2
AP-HM, Hôpital Nord, Service de Gastroentérologie, Aix-Marseille Université, Marseille, France
3
Service de Gastro-entérologie HGEA, 80 av. Augustin Fliche, 34295 Montpellier Cedex 5, France
4
Department of Hepatogastroenterology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
underwent sleeve gastrectomy. In addition to worsening patients’ quality of life, symptomatic reflux increases the incidence of Barrett esophagus in the population operated on for bariatric surgery [1]. In such population, GERD occurrence is determined by the presence of pre-operative reflux, the surgical technique, and the postoperative excess body weight loss. Indeed, the prevalence of reflux after laparoscopic sleeve gastrectomy (LSG) appears to be higher than for Roux-en-Y gastric bypass (RYGBP) with a de novo reflux rate of 9.8 to 23% for LSG versus 1.7% for RYGBP [2]. However, LSG is the most widely used surgery because of its effectiveness and the lower risk of long-term deficiencies, representing more than 60% of all bariatric surgical procedures. In case of severe GERD or refractory to PP
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