Anti-reflux mucosal ablation for refractory gastroesophageal reflux disease after Roux-en-Y gastric bypass

Roux-en-Y gastric bypass (RYGB) is the gold standard bariatric surgical intervention in obese patients with pre-operative gastroesophageal reflux disease (GERD) [1]. Several hypotheses have been proposed to explain GERD recurrence postoperatively, including retained acid-secreting parietal cells in the pouch [2], dysmotility of the Roux limb, and herniation of the gastric pouch through the hiatus. We report the successful treatment of refractory GERD following RYGB using anti-reflux mucosal ablation (ARMA) ([Fig. 1]).