What is ARBL (Anti Reflux Band Ligation)? New Method in Reflux Treatment
Reflux (GERD) is a common condition that occurs when stomach contents back up into the esophagus and can cause complaints such as burning in the chest, bitter water in the mouth, belching, burning sensation in the throat and sometimes chronic cough. In most people, it can be controlled with lifestyle changes and medications. However, in some patients, reflux treatment is not effective enough despite medication, complaints return quickly when the medication is stopped, or questions about long-term medication use arise.
This is where “non-surgical” or less invasive options come to the fore. While different methods have been developed in the field of endoscopic reflux treatment in recent years, one of them is the ARBL (Anti Reflux Band Ligation) approach. So what is ARBL, what does anti-reflux band ligation aim for, how is ARBL procedure performed and what awaits you after the procedure?
In this comprehensive guide, we explain how ARBL works, who it may be suitable for, the risks and the recovery process in a patient-friendly language. We have also included practical tips and frequently asked questions to help you make the right decision.
** Important note: This article is for informational purposes. A gastroenterology or general surgery specialist evaluation is required for a definitive diagnosis and treatment plan.
What is ARBL? What Does Anti Reflux Band Ligation Mean?
ARBL (Anti Reflux Band Ligation) is an approach among endoscopic reflux treatment methods aiming to reduce reflux complaints. the term “band ligation” is based on the logic of controlled taping/ligation of certain tissue areas with the help of a special apparatus during endoscopy. The aim is to contribute to strengthening the reflux barrier by creating healing and tissue remodeling at the junction of the esophagus and stomach (gastroesophageal junction/GEJ) over time.
One of the main problems in reflux is weak functioning of the valve mechanism (lower esophageal sphincter/LES) between the stomach and esophagus and/or disruption of the anatomical barrier in this region. Anti reflux band ligation can be summarized as a method that aims to strengthen this barrier endoscopically without a surgical incision.
In this article, we specifically aim to meet these search intentions:
- what is ARBL (definition and rationale)
- how to do ARBL process (step by step process)
- **What is the place of ARBL in endoscopic reflux treatment options?
- who may be eligible for a Reflux treatment plan?
If you need more basic information, you can also take a look at our content:
How Does ARBL Work? Mechanism (Targeted Impact in LES/GEJ Area)
the answer to the question “**How does ARBL reduce reflux?” starts with understanding where reflux originates from. Reflux complaints are mostly due to the weakening of the barrier at the junction of the esophagus and stomach. Roughly three elements support this barrier:
- LES pressure (cover mechanism)
- Diaphragm support
- Tissue integrity and anatomical structure (GEJ region)
When this system is weakened, stomach contents can escape upwards, especially after a meal, when bending forward or lying down.
the goal of the ARBL (Anti Reflux Band Ligation) approach is to endoscopically create a controlled tissue effect around the GEJ over time:
- Contributing to a stronger barrier in the GEJ region,
- To help reduce the upward escape of stomach contents,
- Provide symptom control that may reduce the need for medication such as PPI in some patients (not guaranteed in all patients) it can happen.
Not all reflux is the same: Why tests are important
Before ARBL and other reflux endoscopic treatment methods are planned, the type and severity of reflux should be clarified. Because:
- Some patients have esophagitis (damage to the esophagus) on endoscopy.
- In others, endoscopy may be normal (non-erosive reflux).
- Some people have throat symptoms (suspected laryngopharyngeal reflux).
- Some may be accompanied by hiatal hernia (gastric hernia), changing the choice of treatment.
Therefore, the physician may order endoscopy and, if necessary, tests such as pH meter and/or esophageal manometry. These tests not only answer the question “is there reflux?” but also “which treatment is more appropriate?”.
Related content:
- What is pH meter test, what does it do in reflux diagnosis?
- What is hiatal hernia, is it related to reflux?
How to Perform ARBL Procedure (Step by Step) + Pre/Post Procedure
the most frequently asked questions about ARBL procedure are: “How many minutes does it take?”, “Is there anesthesia?”, “Can you be discharged the same day?”, “Will there be pain afterwards?”. Although application protocols may vary according to the center, the general flow is as follows:
1) Pre-procedure preparation and evaluation
The physician will usually
- Ask about your complaints, how long they have been going on and your response to medication,
- Evaluates endoscopy findings (esophagitis, suspicion of Barrett’s, etc.),
- Requests pH measurement and/or manometry if necessary,
- Evaluates in terms of hiatal hernia,
- Plans if you are taking medicines such as blood thinners.
This is the most critical step in determining whether ARBL is suitable for you. Because reflux treatment is individualized; a “one size fits all” approach is not correct.
2) Day of ARBL procedure: Endoscopic procedure
- Fasting is requested for a certain period of time (the physician/center informs).
- Intravenous access is opened; sedation may be applied as in most endoscopic procedures.
- The stomach and GEJ region is evaluated with an endoscope.
- Ligation/banding is performed in the appropriate area.
**It may vary according to the patient’s anatomy and application details. Also, the “procedure time” is different from the “total hospital stay”; the total time may be longer due to preparation and observation.
3) First hours after the procedure
Short-term observation may be possible after the procedure. The following complaints may occur in some patients:
- Mild irritation/sensitivity in the throat (due to endoscopy),
- Pressure or pain in the chest,
- Discomfort when swallowing,
- Temporary bloating.
If necessary, your doctor may recommend pain control and gastroprotective/symptom regulating medications.
4) “When should I consult a doctor?” (Alarm symptoms)
After the procedure, contact your healthcare provider without delay in the following cases:
- Severe or increasing chest pain,
- Bloody vomiting
- Black tar-like feces,
- High fever
- Significant and increasing dysphagia,
- Shortness of breath
Although these symptoms are rare, they are important for safety.
For whom may it be suitable? Who may not be recommended? (Indication-Contraindication)
One of the most important factors determining the success of endoscopic reflux treatment methods such as ARBL is the right patient selection. there is no one-sentence answer to the question “**Who is ARBL applied to?”; however, the following topics are frequently brought up in physician evaluation:
###Who may be considered for ARBL?
- Patients with partial response to medication but not complete relief
- People whose symptoms return rapidly after stopping medication and whose quality of life is affected
- Patients who wish to consider less invasive options compared to surgery and who are deemed appropriate by the physician
- People with a clear diagnosis of reflux and no obstacle to endoscopic intervention
Who may not be suitable?
“**Who is not suitable for ARBL?” depends on the individual. In general, the physician may consider different approaches in the following situations:
- Suspicion of large hiatal hernia or obvious anatomical problem,
- Severe esophagitis, stenosis or other lesions requiring emergency treatment,
- Conditions that increase the risk of bleeding,
- Esophageal motility disorder (detectable by manometry) affecting swallowing function.
At this point, the most correct approach is this: **In addition to the question “What is ARBL?”, it is also necessary to answer the question “What type of reflux do I have? Is it suitable for me?” together with the physician.
Content to help make a decision:
Advantages of ARBL, Potential Risks and Nutrition/Recovery after ARBL
Possible advantages (in appropriate patient)
The potential advantages of ARBL may be
- No skin incision due to endoscopic application
- Target reduction in reflux symptoms in some patients
- Possibility of shorter recovery time compared to surgery (depends on the individual)
- evaluation as an alternative for patients seeking “reflux treatment without surgery”
Possible risks and side effects
Like any medical procedure, anti-reflux band ligation may involve risks. Depending on the center and the patient:
- Bleeding,
- Chest pain/discomfort,
- Temporary difficulty swallowing (dysphagia),
- Signs of infection,
- Symptoms do not improve as expected or recur,
- Rare need for hospitalization such possibilities should be addressed in the pre-procedure briefing.
Nutrition after ARBL: Practical advice
the “Nutrition after ARBL” plan directly affects the comfort of recovery. A personalized plan is essential; however, general principles are as follows:
- Soft, non-irritating foods may be preferred in the first days.
- Very hot, spicy, acidic and carbonated drinks may increase discomfort.
- Eating little and often rather than large portions may be better tolerated.
- Stopping eating 2-3 hours before bedtime supports reflux control.
- It is important to keep the follow-up appointments recommended by your doctor.
Content where we compile lifestyle recommendations:
Frequently Asked Questions (FAQs): the Most Common Concerns of Those Researching “What is ARBL?”
Does ARBL hurt?
Since sedation can be applied during the procedure, the perception of pain may be reduced. Pressure/pain in the chest or tenderness in swallowing may occur for a few days afterwards. The intensity and duration varies from person to person.
Is ARBL permanent? Does the reflux go away completely?
The effect of ARBL depends on factors such as the cause of reflux, the presence of hiatal hernia, test results and lifestyle. In some patients, significant relief can be targeted; however, it is not correct to promise a “complete and permanent guarantee”.
Can reflux medication be used after ARBL?
In some patients, the physician may recommend short-term medication or a controlled taper plan. Do not stop the medication on your own.
ARBL or fundoplication?
This comparison is based on the severity of reflux, hiatal hernia, LES function, pH meter/manometry results and the overall risk profile of the patient. While surgery is more appropriate in some patients, endoscopic reflux treatment options may be considered in some patients.
Is the ARBL procedure needed again?
In some patients, a single session may be sufficient; in some cases, additional treatments may be considered depending on the symptoms and evaluation. This should be discussed with the team planning the procedure.
Conclusion: Where Does ARBL Fit in Reflux Treatment?
ARBL (Anti Reflux Band Ligation) is an endoscopic reflux treatment approach that can be evaluated in appropriate patient groups. It may be considered as a “less invasive” option for patients whose complaints persist despite medication or whose complaints recur after stopping medication. However, the success of ARBL depends on the correct diagnosis, correct patient selection, evaluation of concomitant conditions such as hiatal hernia, and personalized post-procedural planning.
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