However, a very common cause of GERD, with few treatment options until now, has been what is known as Cardias Incompetence. The cardia is a valve-like anatomical structure that allows food to pass from the esophagus to the stomach, and limits the passage of gastric contents to the esophagus. In the situation known as Cardias Incompetence, this structure is permanently open, allowing gastric contents to reflux freely into the esophagus.
Through the plastic endoscopy technique known as Antireflux Mucosectomy, ARMS, we can modify the dysfunctional shape of the cardia so that it fulfills its anatomical mission and makes it difficult for the acid content of the stomach to pass into the esophagus.
The ARMS technique, unlike fundoplication, does not alter the gastric anatomy, it only closes the junction between the esophagus and stomach that is abnormally open, causing reflux. It is a procedure that only affects the most superficial layers of the stomach and only requires hospital admission for 24 hours.
How it is performed: through the mouth in the operating room and under orotracheal intubation, a gastroscope with a special rigid plastic cap at the tip is introduced. The respectful mucosal area is marked with a scalpel. Subsequently, physiological saline dyed with indigo carmine is infiltrated into the submucosal layer (as identification). After this, a special polypectomy loop, asymmetrical and more flexible than usual, is loaded into the cap. The immediately subcardial area is confronted, the mucosa is aspirated inside the cap and cut to the muscle with the loop. This entire process is repeated approximately 5-6 times, to cover 90% of the gastric circumference.
It is performed in the operating room and under orotracheal intubation and lasts approximately 60 minutes, with expected discharge in less than 48 hours.
Recovery after the technique is also much faster, and with fewer symptoms.
The Advanced Interventional Endoscopy Unit of the QuirónSalud Hospital in Málaga is a pioneer in the endoscopic treatment of Reflux disease, being one of the few centers in Spain accredited for the endoscopic treatment of hiatal hernia using the MUSE technique, as well as the only center European, public or private, in which the ARMS technique is carried out with excellent results.
