A novel endoscopic treatment for Gastro-Esophageal Reflux Disease (GERD): Anti-Reflux Mucosectomy (ARMS)

- The first-choice treatment for GERD is anti-acid medication, usually a Proton Pump Inhibitor (PPI).
- When PPIs are ineffective, anti-reflux surgery (such as laparoscopic Nissen fundoplication) is generally recommended; however, many patients would prefer to avoid surgery.
- Dr. Haru Inoue (Director and Professor, Digestive Disease Center, Showa University Koto-Toyosu Hospital) has established an “incisionless” endoscopic procedure for the treatment of GERD: the Anti-Reflux Mucosectomy (ARMS).
- Many GERD patients have small hiatal hernias (dilation of the gastro-esophageal opening). By removing the redundant mucosa during the ARMS procedure, the gastro-esophageal flap remodels into an effective anti-reflux valve during the healing process.
- The ARMS procedure re-creates the normal anatomy at the gastro-esophageal junction, without any distortion (like in the Nissen) and without any implanted foreign bodies. - The first ARMS procedure was performed more than 10 years ago, and the procedure is safe even in long-term follow-up.
- The ARMS procedure has been approved by the Ethics Boards of both Showa University Northern Yokohama Hospital and Showa University Koto-Toyosu Hospital.
- As of February 2015, a total of 25 patients have received the ARMS procedure. GERD symptoms were effectively controlled in all cases, and there were no major complications. Importantly, none of the patients who received a semi-circular ARMS procedure developed any strictures.
- The ARMS procedure has been presented at Digestive Disease Week (DDW), the annual congress of the American Society for Gastrointestinal Endoscopy (ASGE), and published in peer-reviewed international scientific journals.


1. Satodate H, Inoue H et al. Circumferential EMR of carcinoma arising in Barrett's esophagus: case report. Gastrointest Endosc 2003; 58: 288-92
2. Satodate H, Inoue H et al. Squamous reepithelialization after circumferential mucosal resection of superficial carcinoma arising in Barrett's esophagus. Endoscopy 2004; 36: 907-12
3. Inoue H, Ito H, Ikeda H et al. Anti-reflux mucosectomy for gastroesophageal reflux disease in the absence of hiatus hernia: a pilot study. Ann Gastroenterol 2014; 27: 346-51



If you have any question, please contact Dr. Noboru Yokoyama (Associate Professor,
E-mail:noboru.y@med.showa-u.ac.jp).