Efficacy and Safety of Anti-Reflux Mucosectomy versus Radiofrequency Ablation of the Lower Esophageal Sphincter for the Treatment of Gastroesophageal Reflux Disease: A Systematic Review and Meta-Analysis.

Background And Aims: Gastroesophageal reflux disease (GERD) affects 10-30% of the population. Endoscopic anti-reflux therapies have been proposed for carefully selected patients. The aim of this study was to compare outcomes between endoscopic anti-reflux mucosectomy (ARMS) and endoscopic radiofrequency ablation of the lower esophageal sphincter (Stretta procedure) for the treatment of GERD.

Methods: A systematic review using the Medline database was performed to identify original articles analyzing outcomes after ARMS and Stretta procedures. Main outcomes included patient satisfaction, GERD-HRQL scores, PPI usage, and DeMeester scores. Post-procedural complications were included as secondary outcomes. A meta-analysis of proportions and linear regression models were used to assess the effect of each endoscopic procedure on the different outcomes.

Results: A total of 66 studies comprising 3,767 patients were included; 3,074 (81.60%) underwent Stretta and 693 (18.40%) ARMS. The weighted pooled patient satisfaction was 65% (95% CI, 52%-76%) for ARMS and 77% (95% CI, 64%-87%) for Stretta. Both treatments significantly reduced PPI use (ARMS: from 100% to 40.18% vs. Stretta: from 99.42% to 48.51%, p=0.20) and improved GERD-HRQL scores (ARMS: pre 19.75 to post 8.24 vs. Stretta: pre 21.02 to post 10.45, p=0.70). DeMeester scores improved similarly after both procedures (ARMS: pre 44.99 to post 15.02 vs. Stretta: pre 52.29 to post 28.99, p=0.48). ARMS was associated with higher overall morbidity (ARMS: 25% vs. Stretta: 17%, p=0.001) and greater risks of stricture (OR 13.03, 95% CI 7.83-21.71), bleeding (OR 13.16, 95% CI 8.60-20.15), and perforation (OR 13.03, 95% CI 7.82-21.71) compared to Stretta.

Conclusions: Both Stretta and ARMS are effective endoscopic treatment modalities for GERD. Although their clinical efficacy appears to be similar, the increased risk of dysphagia, bleeding, and perforation after ARMS should not be underestimated.