Antireflux myoplasty: Endoscopic myoplasty with bilateral sling fiber plication for refractory gastroesophageal reflux disease

Endoscopic antireflux therapy is a novel endoscopic treatment for refractory gastroesophageal reflux disease. We developed antireflux myoplasty (AR-MP), a modified version of antireflux mucoplasty (ARM-P), in which exposed bilateral sling fibers are sutured directly via endoscopic hand-suturing. AR-MP was performed on a 60-year-old man, resulting in symptomatic improvement and allowing discontinuation of acid-suppressive medication 3 months after the procedure. One month postoperatively, endoscopy showed an improvement in the Hill classification from grade 3 to grade 1. Before AR-MP, endoscopic pressure study integrated system findings showed a maximum intragastric pressure value of 13.7 mmHg, indicating a flat pattern. After AR-MP, maximum intragastric pressure exceeded 20 mmHg, and the pattern shifted to uphill. AR-MP is an innovative endoscopic technique that reconstructs the native antireflux mechanism by suturing the sling fibers and reforming the gastroesophageal flap valve. This innovative endoscopic procedure, like ARM-P, provides immediate symptom relief and represents a breakthrough in the endoscopic treatment of gastroesophageal reflux disease.