Anti-reflux mucosectomy is associated with better short-term symptoms than double-dose proton pump inhibitor in reflux esophagitis patients

Figure 1 Study flow diagram illustrating patient enrollment and group allocation. Patients with reflux esophagitis were allocated into two groups: The anti-reflux mucosectomy group and the double-dose proton pump inhibitor group. Follow-up assessments were conducted at 3 weeks and 3 months post-treatment, including the collection of baseline information such as gastroesophageal reflux disease questionnaire scores, LA classification, quality of life, and mental health status. RE: Reflux esophagitis; PPI: Proton pump inhibitor; ARMS: Anti-reflux mucosectomy; GERDQ: Gastroesophageal reflux disease questionnaire; QoL: Quality of life.

Figure 2 Endoscopic views of the anti-reflux mucosectomy procedure. A: Endoscopic view of the esophagogastric junction showing mild dilation of the cardia; B: Marking of the resection margin along the lesser curvature, covering half the circumference; C: Submucosal injection to lift the mucosa; D: Mucosal incision using endoscopic submucosal dissection technique; E: Submucosal dissection progressing toward the gastric side; F: Completion of semicircular mucosectomy along the lesser curvature; G: Final view of the mucosal defect after resection, expected to result in scar-induced tightening of the esophagogastric junction.

Figure 3 Quality of life outcomes of anti-reflux mucosectomy proton pump inhibitor and double-dose proton pump inhibitor groups in terms of reflux symptom index, gastroesophageal reflux disease-health-related quality of life, gastroesophageal reflux disease questionnaire and reflux disease questionnaire scores preoperatively and at different time points postoperatively. PPI: Proton pump inhibitor; ARMS: Anti-reflux mucosectomy; RSI: Reflux symptom index; GERDQ: Gastroesophageal reflux disease questionnaire; GERD-HRQL: Gastroesophageal reflux disease-health-related quality of life; RDQ: Reflux disease questionnaire.

Figure 4 Gastroscopic findings three months post-anti-reflux mucosectomy. Follow-up endoscopy revealed fibrotic changes and narrowing at the esophagogastric junction, consistent with the intended anti-reflux effect of mucosal scarring. The image shows typical post-anti-reflux mucosectomy appearance with reduced patency of the cardia, contributing to mechanical prevention of reflux.