Antireflux Ablation Therapy (ARAT) Vs Antireflux Mucosectomy (ARMS) In The Management Of Gastroesophageal Reflux Disease
Gastroesophageal Reflux Disease
About this trial
This is an interventional treatment trial for Gastroesophageal Reflux Disease focused on measuring Gastroesophageal Reflux Disease (GERD), ARAT, ARMS
Eligibility Criteria
Inclusion Criteria:
- Patients of both sexes over 18 years and under 90 years with a diagnosis of GERD and who are under medical treatment and who do not want surgical treatment.
- Confirmed diagnosis of GERD as follows:
Positive pHmetry. Positive endoscopy (Esophagitis grade C, D, stenosis or EB)
- Esophagogastric junction Hill I-III
- Total or partial response to proton pump inhibitors
- Patient who does not wish to take medication for the treatment of gastroesophageal reflux in the long term or indefinitely or refractory GERD
Exclusion Criteria:
- Patients who do not accept the signature of the informed consent
- Postoperative fundoplication patients for GERD
- Patients with extraesophageal symptoms.
- Pregnant women.
- Patients with hiatal hernia larger than 3 cm or Hill type IV.
- Patients with major esophageal motility disorders.
- Patients with portal hypertension and presence of esophageal varices
- Patients with hemophilia or some haematological disorder that is difficult to control
- Patients with malignant pathology of the esophagus or Gastroesophageal Junction (GEJ).
Sites / Locations
- Centro Medico Nacional Siglo XXI Hospital de EspecialidadesRecruiting
Arms of the Study
Arm 1
Arm 2
Active Comparator
Active Comparator
Hybrid argon plasma.
Band mucosectomy
After diagnostic endoscopy investigators will proceed to use argon plasma probe for marking 270 grades around the esophagogastric junction preserving part of the mucosa towards the greater curvature, then investigators will use the jet included in the argon plasma probe with effect 20 to 40 system for the injection of the background submucosa in the marking area, applying 0.9% saline solution with methylene blue, to achieve adequate Submucosal elevation for application or argon plasma with high voltages (100 watts, 1.5 liters / min) using forced coagulation mode, applying plasma argon to 1cm above the Z line in the esophageal mucosa and 2cm below it towards the gastric mucosa, argon will be applied until a "carbonization" effect of the mucosa is achieved, once the application of the therapy is performed mucosal lavage and immersion technique to corroborate integrity and continuity of the gastrointestinal tract and rule out immediate complications
After diagnostic endoscopy investigators will proceed to use the tip of a polypectomy snare for marking 270 grades around the esophagogastric junction preserving part of the mucosa towards the greater curvature, then investigators will perform submucosal elevation with the injection of 0.9% saline with carmine indigo and adrenaline 1:10000, after adequate submucosal elevation investigators will proceed with the help of a band ligation cap to suction and release the elastic band in the previously marked and elevated tissue, proceeding to resect the previously ligated tissue with polypectomy loop below the elastic band with forced coagulation (Effect 2, 40 W), until the marked mucosa is completely resected (average used of 5 elastic bands, reviewing the work area for complications like bleeding or perforation.