Clinical Utility of Anti‐reflux Mucosal Intervention for Refractory Gastroesophageal Reflux Disease in Patients With a Hiatal Hernia

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Background: Surgical fundoplication is the standard treatment for refractory gastroesophageal reflux disease (GERD) with large (≥3 cm) hiatal hernias; however, its invasiveness is problematic in older adults and high-risk patients. Anti-reflux mucosal intervention (ARMI) is a less invasive endoscopic alternative; however, patients with large hernias have previously been excluded from studies, limiting available evidence. We assessed the feasibility, short-term clinical outcomes, and safety of ARMI in this population. Methods: We retrospectively analyzed consecutive patients with proton pump inhibitor (PPI)/potassium-competitive acid blocker (P-CAB)-refractory GERD and sliding hiatal hernias ≥3 cm who underwent ARMI (anti-reflux mucosectomy; anti-reflux mucoplasty) between April 2024 and April 2025. GERD-Health-Related Quality of Life (GERD-HRQL), GERD Questionnaire (GerdQ), and Frequency Scale for the Symptoms of GERD (FSSG) scores were compared before ARMI and 3 months afterward. PPI/P-CAB discontinuation and treatment-related adverse events were also assessed. Results: = 0.008). PPI/P-CAB was discontinued in seven patients. No clinically significant treatment-related adverse events, including perforation, delayed bleeding, or dysphagia, occurred. Conclusions: ARMI was technically feasible, showed favorable short-term outcomes in patients with refractory GERD and 3-6-cm hiatal hernias, and may represent a less invasive option for older or high-risk patients. Trial Registration: N/A.

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