Delivery of radiofrequency energy to the lower oesophageal sphincter and gastric cardia inhibits transient lower oesophageal sphincter relaxations and gastro-oesophageal reflux in patients with reflux disease

Abstract

Background and aims: Radiofrequency energy (RFe) treatment to the lower oesophageal sphincter (LOS) and gastric cardia is a new luminally delivered therapy proposed as an alternative treatment for gastro-oesophageal reflux disease (GORD). However, it is unclear how RFe achieves its antireflux effect. This study investigated the effects of RFe on mechanisms of spontaneous reflux in patients with GORD. Methods: Twenty patients with GORD underwent endoscopy, symptom evaluation, and combined postprandial oesophageal manometry and pH monitoring before and six months after RFe, and 24 hour ambulatory pH monitoring before and at six and 12 months after treatment. Results: RFe reduced the rate of postprandial transient LOS relaxations from 6.8 (5.7-8.1) (median (interquartile range) per hour to 5.2 (4.2-5.8) per hour (p<0.01), and increased mean basal LOS pressure from 5.2 (SEM 0.3) mm Hg to 8.0 (SEM 0.4) mm Hg (p<0.01). The number of reflux events was reduced from 10 (2-15.3)/3 hours to 5 (3.5-8.5)/3 hours (p<0.05) and there was an associated significant reduction in acid exposure time from 5.4% (0.4-14.7) to 3.9% (0.4-6.6) (p<0.05). RFe significantly reduced ambulatory oesophageal acid exposure from 10.6% (7.8-13.0) to 6.8% (3.1-9.1) (p<0.01) at six months and 6.3% (4.7-10.9) (p<0.05) at 12 months. All patients required acid suppressant medication for symptom control before RFe. Six months after treatment, 15 patients (75%) were in symptomatic remission and 13 (65%) at 12 months. Conclusions: RFe has significant effects on LOS function that are associated with improvement in the antireflux barrier. Uncontrolled clinical data also suggest a beneficial effect in the control of reflux symptoms in these patients.

Delivery of radiofrequency energy to the gastroesophageal junction (Stretta procedure) for the treatment of gastroesophageal reflux disease

“…Recently, a number of endoscopic antireflux procedures have been described, with the common goal of creating an antireflux barrier, thus obviating long-term PPIs and the cost and potential risk of laparoscopic surgery [6,10,12,23], offering selected GERD patients a potential alternative to long-term medication use or surgery. Radiofrequency (RF) energy treatment to the lower esophageal sphincter (LES) and gastric cardia (Stretta procedure) is increasingly offered as first-line therapy before more invasive surgical procedures for selected GERD patients, with clinical data supporting its efficacy, safety, and patient satisfaction [4,5,15,20,21,23,26]. The current study reports the results of the Italian experience on the efficacy and safety of RF energy delivery to LES in the treatment of selected GERD patients with prolonged follow-up.…”

Endoscopic Therapy for Gastroesophageal Reflux Disease: A Systematic Review

“…Secondly, progressive tissue remodeling and scar formation observed after Stretta could contribute to the decreased compliance and an increased tensile strength of the GEJ which also exerts its effect in decreasing tLESRs. This decrease in tLESRs has been shown in both animals and humans [43, 54]. Histologically normal muscle with occasional focal areas of collagen deposition at 8 weeks’ follow-up has been shown in the porcine model.…”

New Options for the Management of GERD

“…4). It is reported that the therapy remodels the LES and gastric cardia musculature, thereby improving reflux control by decreasing both the number of lower esophageal sphincter relaxation episodes (tLESR) [24] and GEJ compliance, which is thought to be due to a neuro-ablative mechanism rather than tissue fibrosis [25].…”