S2256 Efficacy and Safety of Anti-Reflux Mucosal Ablation in Proton Pump Inhibitors Refractory Gastroesophageal Reflux Disease: A Systematic Review and Meta-Analysis

Introduction: Gastroesophageal reflux disease (GERD) refractory to the Proton pump inhibitors (PPI) poses a serious clinical challenge. New endoscopic minimally invasive procedures, causing cardiac remodeling, have emerged. This meta-analysis aimed to evaluate the efficacy and safety of the less invasive approach called Anti-reflux mucosal ablation (ARMA) in GERD. Methods: Electronic databases including PubMed, Cochrane Central and ScienceDirect were searched from inception till January 2025. This review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The pooled analysis was performed using a random effects model in R version 4.2.3 employing the “metaprop” package. The primary and secondary outcomes of interest were clinical success rate at short-term (<1 year) and long-term (≥1 year) follow-ups, adverse events, dysphagia requiring dilation and Gastroesophageal reflux disease health-related quality of life (GERD-HRQL) score. The quality assessment was done by the Newcastle Ottawa Scale. Publication bias was assessed visually through funnel plots. Results: Five studies encompassing a total of 294 patients were included in this meta-analysis. The pooled clinical success rates at short and long follow-ups were 72% (95% CI:[56-84%]; I2 = 70.8%) and 73% (95% CI:[19-97%]; I2 = 0%) respectively. The pooled adverse effects were 18% (95% CI:[4-54%]; I2 = 91.6%). Among these adverse effects, the dysphagia requiring dilation was 13% (95% CI:[7-22%]; I2 = 0%). Conclusion: This meta-analysis showed that ARMA has a high clinical success rate along with low incidence of adverse effects implying that it is a safe and effective minimally invasive endoscopic treatment modality for GERD resistant to PPI.