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World Journal of Gastrointestinal Surgery
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1948-9366
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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©The Author(s) 2025.
World J Gastrointest Surg. Nov 27, 2025; 17(11): 111815
Published online Nov 27, 2025. doi: 10.4240/wjgs.v17.i11.111815
Table 10 Options of anti-reflux mucosal intervention for refractory gastroesophageal reflux disease patients with different comorbidities
Patient populationIntervention options
ARMS
ARMA
PECC
Hiatal herniaNoNARecommendedRecommendedRecommended
Yes≤ 2 cmRecommendedRecommendedRecommended
2-3 cmRecommendedRecommendedOptional
3-5 cmOptionalNot recommendedNot recommended
Hill gradeI-IINARecommendedRecommendedRecommended
IIINARecommendedRecommendedNot recommended
IVNARecommendedNot recommendedNot recommended
Barrett’s esophagusNoNARecommendedRecommendedRecommended
YesShort BERecommendedNot recommendedNot recommended
Long BENot recommendedNot recommendedNot recommended
Esophagitis (Los Angeles’s grade)LA-A - LA-BNARecommendedRecommendedRecommended
LA-CNAOptionalNot recommendedOptional
LA-DNANot recommendedNot recommendedNot recommended
AgeYoung (refusal of surgical procedures)NARecommendedRecommendedRecommended
Old (inability to tolerate surgical procedures) NARecommendedRecommendedRecommended
Previous history of upper gastrointestinal surgery1NoNARecommendedRecommendedRecommended
YesNARecommendedOptionalOptional
Presence of mucosal abnormalities2NoNARecommendedRecommendedRecommended
YesNARecommendedNot recommendedNot recommended
1Previous history of upper gastrointestinal surgery: Any prior upper gastrointestinal operation involving the lower esophagus, gastric cardia, or stomach, which may compromise surgical access and complicate surgical anti-reflux procedures.
2Presence of mucosal abnormalities: Confirmed or suspected mucosal abnormalities (e.g., Barrett’s esophagus) in the esophagogastric junction region requiring histopathological confirmation.
BE: Barrett’s esophagus; ARMS: Anti-reflux mucosectomy; ARMA: Anti-reflux mucosal ablation; PECC: Peroral endoscopic cardial constriction; NA: Not available.
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