Supplementary Material for: Endoscopic Anti-reflux Mucosal Interventions for Gastroesophageal Reflux Disease: A Systematic Review and Meta-Analysis of Efficacy, Safety, and Comparative Outcomes

Abstract
Background: This meta-analysis evaluates efficacy and safety of anti-reflux mucosal interventions (ARMIs) for gastroesophageal reflux disease (GERD), and comparative effectiveness against traditional interventions.
Methods: A systematic search identified 37 studies (11 comparative and 26 single-arm studies) evaluating ARMIs. Outcomes included GERD symptom scores (GERD-Q, GERD-HRQL), DeMeester score, acid exposure time (AET), complete cessation of proton-pump inhibitor (PPI) therapy, and adverse events (AEs). Random-effects models pooled standardized mean differences (SMDs) and risk ratios (RRs). Subgroup analyses compared techniques (endoscopic mucosal resection [EMR], endoscopic submucosal dissection [ESD], anti-reflux mucosal ablation [ARMA]).
Results: Technical success was 100%, with a mean procedure time of 42.09 minutes. ARMIs significantly reduced the proportion of patients using PPI (RR=2.22-3.06; <3–24 months; P≤0.001) and improved GERD-Q, GERD-HRQL, and DeMeester scores through 36 months (P<0.05). AET decreased at 3–6 months (P<0.001). Overall AEs occurred in 13% of cases (bleeding: 3%; stricture: 8%; dysphagia: 8%). Subgroup analyses demonstrated efficacy across EMR, ESD, and ARMA subtypes (P<0.05), though AE rates differed. Compared to LNF, ARMIs showed similar symptom relief (P>0.05), shorter procedures (P<0.001), and lower dysphagia (X% vs. Y%; P=0.01). Versus Stretta, ARMIs had similar PPI discontinuation rates (P=0.258) and GERD-Q improvement (P=0.696).
Discussion: ARMIs offer durable symptom control with reduced PPI dependency. Preliminary comparative data suggest potential efficacy/safety advantages over LNF/Stretta, warranting randomized trials. Technique selection should balance efficacy and AE profiles.