S2256 Efficacy and Safety of Anti-Reflux Mucosal Ablation in Proton Pump Inhibitors Refractory Gastroesophageal Reflux Disease: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Introduction: Gastroesophageal reflux disease (GERD) refractory to the Proton pump inhibitors (PPI) poses a serious clinical challenge. New endoscopic minimally invasive procedures, causing cardiac remodeling, have emerged. This meta-analysis aimed to evaluate the efficacy and safety of the less invasive approach called Anti-reflux mucosal ablation (ARMA) in GERD. Methods: Electronic databases including PubMed, Cochrane Central and ScienceDirect were searched from inception till January 2025. This review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The pooled analysis was performed using a random effects model in R version 4.2.3 employing the “metaprop” package. The primary and secondary outcomes of interest were clinical success rate at short-term (<1 year) and long-term (≥1 year) follow-ups, adverse events, dysphagia requiring dilation and Gastroesophageal reflux disease health-related quality of life (GERD-HRQL) score. The quality assessment was done by the Newcastle Ottawa Scale. Publication bias was assessed visually through funnel plots. Results: Five studies encompassing a total of 294 patients were included in this meta-analysis. The pooled clinical success rates at short and long follow-ups were 72% (95% CI:[56-84%]; I2 = 70.8%) and 73% (95% CI:[19-97%]; I2 = 0%) respectively. The pooled adverse effects were 18% (95% CI:[4-54%]; I2 = 91.6%). Among these adverse effects, the dysphagia requiring dilation was 13% (95% CI:[7-22%]; I2 = 0%). Conclusion: This meta-analysis showed that ARMA has a high clinical success rate along with low incidence of adverse effects implying that it is a safe and effective minimally invasive endoscopic treatment modality for GERD resistant to PPI.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.016 | 0.029 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.020 | 0.048 |
| Bibliometrics | 0.007 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".