PMID- 32343977
OWN - NLM
STAT- MEDLINE
DCOM- 20210319
LR  - 20210319
IS  - 1097-6779 (Electronic)
IS  - 0016-5107 (Linking)
VI  - 92
IP  - 6
DP  - 2020 Dec
TI  - Clinical feasibility of a new antireflux ablation therapy on gastroesophageal 
      reflux disease (with video).
PG  - 1190-1201
LID - S0016-5107(20)34245-0 [pii]
LID - 10.1016/j.gie.2020.04.046 [doi]
AB  - BACKGROUNDS AND AIMS: New mucosal resective and ablative endoscopic procedures 
      based on gastric cardiac remodeling to prevent reflux have appeared. We aimed to 
      evaluate the feasibility of a new ablative technique named antireflux ablation 
      therapy (ARAT) for control of GERD in patients without hiatal hernia. METHODS: 
      Patients with proton pump inhibitor (PPI)-refractory GERD without hiatal hernia 
      underwent ARAT between January 2016 and October 2019. Gastroesophageal Reflux 
      Disease-Health-Related Quality of Life (GERD-HRQL), upper endoscopy, 24-hour pH 
      monitoring, and PPI use were documented at 3, 6, 12, 24, and 36 months after 
      ARAT. RESULTS: One hundred eight patients were included (61 men [56.5%]; median 
      age, 36.5 years; range, 18-78 years). ARAT was performed on all patients. At the 
      36-month evaluation, 84 patients had completed the protocol. Median ARAT time was 
      35.5 minutes (range, 22-51 minutes), and median circumference ablation was 300 degrees  
      (range, 270 degrees -320 degrees ). No major adverse events occurred, and 14 of 108 patients 
      (12.9%) presented with stenosis that was responsive to balloon dilation (<5 
      sessions). At the 3-month evaluation, the acid exposure time (AET), DeMeester 
      score, and GERD-HRQL score had decreased from 18.8% to 2.8% (P = .001), 42.5 to 
      9.1 (P = .001), and 36.5 to 10 (P = .02), respectively, and these values were 
      maintained up to 36 months. Success (AET <4%) was achieved in 89% and 72.2% at 3 
      and 36 months, respectively. Related factors at 36 months were as follows: 
      pre-ARAT Hill type II (odds ratio [OR], 3.212; 95% confidence interval [CI], 
      1.431-5.951; P = .033), post-ARAT 3-month Hill type I (OR, 4.101; 95% CI, 
      1.812-9.121; P = .042), and AET <4% at 3 months (OR, 5.512; 95% CI, 1.451-7.621; 
      P = .021). CONCLUSIONS: ARAT is a feasible, safe, and effective therapy for early 
      and mid-term treatment of GERD in patients without a sliding hiatal hernia. 
      However, longer follow-up evaluations and randomized comparative studies are 
      needed to clarify its real role. (Clinical trial registration number: 
      NCT03548298.).
CI  - Copyright (c) 2020 American Society for Gastrointestinal Endoscopy. Published by 
      Elsevier Inc. All rights reserved.
FAU - Hernandez Mondragon, Oscar Victor
AU  - Hernandez Mondragon OV
AD  - Division of Endoscopy, Specialties Hospital, National Medical Center Century XXI, 
      Mexico City, Mexico.
FAU - Zamarripa Mottu, Raul Antonio
AU  - Zamarripa Mottu RA
AD  - Division of Endoscopy, Specialties Hospital, National Medical Center Century XXI, 
      Mexico City, Mexico.
FAU - Garcia Contreras, Luis Fernando
AU  - Garcia Contreras LF
AD  - Division of Endoscopy, Specialties Hospital, National Medical Center Century XXI, 
      Mexico City, Mexico.
FAU - Gutierrez Aguilar, Raul Alberto
AU  - Gutierrez Aguilar RA
AD  - Division of Endoscopy, Specialties Hospital, National Medical Center Century XXI, 
      Mexico City, Mexico.
FAU - Solorzano Pineda, Omar Michel
AU  - Solorzano Pineda OM
AD  - Division of Endoscopy, Specialties Hospital, National Medical Center Century XXI, 
      Mexico City, Mexico.
FAU - Blanco Velasco, Gerardo
AU  - Blanco Velasco G
AD  - Division of Endoscopy, Specialties Hospital, National Medical Center Century XXI, 
      Mexico City, Mexico.
FAU - Murcio Perez, Enrique
AU  - Murcio Perez E
AD  - Division of Endoscopy, Specialties Hospital, National Medical Center Century XXI, 
      Mexico City, Mexico.
LA  - eng
SI  - ClinicalTrials.gov/NCT03548298
PT  - Journal Article
PT  - Video-Audio Media
DEP - 20200425
PL  - United States
TA  - Gastrointest Endosc
JT  - Gastrointestinal endoscopy
JID - 0010505
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
CIN - Gastrointest Endosc. 2020 Dec;92(6):1202-1203. PMID: 33236992
MH  - *Ablation Techniques/methods
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Endoscopy, Gastrointestinal
MH  - Esophageal pH Monitoring
MH  - Feasibility Studies
MH  - Female
MH  - *Fundoplication
MH  - *Gastroesophageal Reflux/drug therapy/surgery
MH  - *Hernia, Hiatal/drug therapy/surgery
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Prospective Studies
MH  - Proton Pump Inhibitors/therapeutic use
MH  - Quality of Life
MH  - Treatment Outcome
MH  - Young Adult
EDAT- 2020/04/29 06:00
MHDA- 2021/03/20 06:00
CRDT- 2020/04/29 06:00
PHST- 2020/01/28 00:00 [received]
PHST- 2020/04/09 00:00 [accepted]
PHST- 2020/04/29 06:00 [pubmed]
PHST- 2021/03/20 06:00 [medline]
PHST- 2020/04/29 06:00 [entrez]
AID - S0016-5107(20)34245-0 [pii]
AID - 10.1016/j.gie.2020.04.046 [doi]
PST - ppublish
SO  - Gastrointest Endosc. 2020 Dec;92(6):1190-1201. doi: 10.1016/j.gie.2020.04.046. 
      Epub 2020 Apr 25.