S1029 Endoscopic Anti-Reflux Mucosectomy Versus Stretta Radiofrequency Ablation in the Treatment of Gastroesophageal Reflux Disease: A Systematic Review and Meta-Analysis

Introduction: Gastroesophageal reflux disease (GERD) unresponsive to proton pump inhibitors (PPI) poses a significant clinical challenge as the treatment options are limited. Recently minimally invasive procedures including endoscopic anti-reflux mucosectomy (ARMS) and Stretta radiofrequency ablation (SRF) have emerged as newer treatment modalities for resistant GERD, however, direct comparison between the 2 are sparse. This meta-analysis compares the safety and efficacy of the ARMS and SRF for GERD. Methods: Electronic databases including PubMed, Cochrane Central, and ScienceDirect were searched from inception to January 2025. Risk ratios (RR) and mean differences (MD) along with 95% confidence intervals (CI) were pooled under the random effects model using the Review Manager version 5.4.1 for the dichotomous and continuous outcomes respectively. The primary and secondary endpoints of interest are the Gastroesophageal Reflux Disease Questionnaire (GERDQ) score, PPI withdrawal rate, symptom improvement rate, technical success rate and adverse effects. Quality assessment was done through the Cochrane Risk of Bias (RoB) 2.0 tool and the Newcastle Ottawa Scale. A leave-one-out sensitivity analysis was performed to investigate the cause of heterogeneity. Publication bias was assessed visually through funnel plot and statistically through Egger's regression test. Results: Three studies pooling a total of 480 patients were included in the quantitative synthesis. The ARMS group decreased the GERDQ score, but the results were statistically insignificant (RR -0.36; 95% CI [-0.87, 0.15]; P = 0.16; I2 = 0%). Other efficacy outcomes including PPI withdrawal rate (RR 0.84; 95% CI [0.55, 1.29]; P = 0.43; I2 = 77%), symptom improvement rate (RR 1.02; 95% CI [0.94, 1.10]; P = 0.66; I2 = 0%), and technical success rate (RR 1.00; 95% CI [0.99, 1.01]; P = 1.00; I2 = 0%) were comparable between the ARMS and SRF group. Similarly, regarding the safety profile, the 2 groups showed no significant difference in the adverse effects (RR 7.80; 95% CI [0.18,341.10]; P = 0.29; I2 = 89%). Conclusion: Both ARMS and SRF demonstrated comparable outcomes in terms of efficacy and safety for the treatment of GERD unresponsive to PPIs, suggesting that either of these minimally invasive procedures may be considered viable therapeutic options, with the choice of intervention potentially guided by physician expertise, patient preference, and resource availability.