A novel endoscopic approach for refractory gastroesophageal reflux disease after laparoscopic sleeve gastrectomy: endoscopic anti-reflux mucosectomy.

INTRODUCTION: Gastroesophageal reflux disease (GERD) is a relatively common complication following laparoscopic sleeve gastrectomy (LSG), with refractory GERD often necessitating revisional surgery. We report two cases of refractory GERD after LSG that were managed with endoscopic anti-reflux mucosectomy (ARMS). CASE PRESENTATION: Case 1: A 58-year-old woman with morbid obesity (BMI 42.2 kg/m2) complicated by hypertension, dyslipidemia, and sleep apnea syndrome underwent LSG. Postoperatively, vomiting symptoms developed approximately two weeks after LSG and worsened over the subsequent year. ARMS was performed one year and three months after LSG. Two months after ARMS, the patient achieved symptomatic and endoscopic improvement while continuing P-CAB therapy. Case 2: A 53-year-old woman with morbid obesity (BMI 41.4 kg/m2) complicated by diabetes, dyslipidemia, hypertension, and sleep apnea syndrome underwent LSG. Postoperatively, she developed medication-refractory GERD. Revisional Roux-en-Y gastric bypass was considered; however, given her history of multiple abdominal surgeries and her preference, ARMS was performed two years after LSG. Two years after ARMS, the patient remained in symptomatic and endoscopic remission, with an improved GERD-HRQL score. CONCLUSIONS: ARMS may be a valuable treatment option for GERD after LSG, potentially bridging medical therapy and revisional surgery while reducing patient burden.