Purpose&#xa0;of Review <p>Gastroesophageal reflux disease is prevalent and has a complex pathophysiology. Though medications are first line, a significant proportion of patients are refractory to this treatment and require anti-reflux surgery (ARS). Though surgery has proven safe and effective, most patients and referring providers are reluctant. Anti-Reflux Mucosectomy (ARMS) provides a less invasive alternative treatment option. This review aims to report our experience with ARMS, discuss other technical variations used, and future directions.</p> <p>Recent Findings</p> <p>In our experience, we note improvement in dysphagia with the modified butterfly-shaped mucosal resection, leading to shorter length of stay, quicker recovery, and equivalent QOL outcomes compared to ARS. We note similar efficacy and safety profiles for anti-reflux mucosal ablation, anti-reflux mucosectomy with cap-assisted mucosal resection, peroral endoscopic cardial constriction, and resection and plication.</p> Summary <p>ARMS and its variations show safety and efficacy as alternative non-invasive treatment options for appropriately selected patients with refractory GERD.</p>