Background: Antireflux mucosal ablation (ARMA) is a novel, minimally invasive endoscopic technique for the treatment of gastroesophageal reflux disease (GERD). Our case report evaluates the feasibility and early clinical outcomes of ARMA in a neurologically impaired pediatric patient with refractory GERD. Case description: A 9-year-old boy with spastic cerebral palsy presented with severe GERD refractory to a long-term proton pump inhibitor therapy. He suffered from profound oropharyngeal dysphagia and recurrent aspiration pneumonia requiring multiple hospitalization. An endoscopic ARMA procedure was performed under general anesthesia without intra-procedural complications or immediate adverse events. Early follow-up revealed improved reflux control, enhanced tolerance of gastrostomy feeding, and a reduced need for acid-suppressive therapy. No respiratory deterioration or procedure-related complications were observed. Conclusions: ARMA is a technically feasible, minimally invasive option for refractory GERD. While this initial case involved a high-risk, neurologically impaired child, the mechanism suggests broader applicability to other pediatric patients with medication-resistant GERD.

Background/Objectives: Management of prehepatic portal hypertension involves endoscopic and medical therapies with subsequent shunting if symptoms persist. Lately, surgical shunts, particularly the Meso-Rex shunt, are increasingly considered early in the disease course, offering benefits such as minimized hyperammonemia, improved somatic growth, and preservation of liver function. Our study evaluates post-operative outcomes after different surgical procedures in children with prehepatic portal hypertension. Methods: This single-centre retrospective case series included six children undergoing surgical shunting for prehepatic portal hypertension over a 5-year period. Medical records before and after surgery, followed for an average of 4.0 years, were analyzed. Results: Five patients underwent a Meso-Rex bypass, while one patient underwent a mesorenal shunt procedure. All cases showed clinically significant regression of esophageal varices six months post-surgery. Thrombocyte as well as leukocyte count significantly increased in five out of six patients during the long-term follow-up. Currently, five out of six surgically formed shunts (83%) continue to function normally. Conclusions: Our study supports early surgical intervention for improved long-term outcomes in managing portal hypertension, reducing complications like hypersplenism and variceal bleeding. Early consideration and ongoing monitoring are crucial for long-term success in children with portal hypertension.