Endoscopic radiofrequency Stretta therapy reduces proton pump inhibitor dependency and the need for anti-reflux surgery for refractory gastroesophageal reflux disease

Abstract

Background/Aims: Radiofrequency treatment of the gastroesophageal junction using the Stretta procedure for treating gastroesophageal reflux disease (GERD) is observed to improve the symptoms and proton pump inhibitor (PPI) dependence and reduce the need for anti-reflux operations. As one of the largest studies in Europe, we evaluated the clinical outcomes of Stretta in patients with medically refractory GERD.Methods: A tertiary UK center evaluated all patients with refractory GERD who underwent Stretta between 2014 and 2022. Patients and primary care professionals were contacted to obtain information regarding the initiation of PPI and reintervention after Stretta.Results: Of the 195 patients (median age, 55 years; 116 women [59.5%]) who underwent Stretta, PPI-free period (PFP) data were available for 144 (73.8%) patients. Overall, 66 patients (45.8%) did not receive PPI after a median follow-up of 55 months. Six patients (3.1%) underwent further interventions. The median PFP after Stretta was 41 months. There was a significant negative correlation between PFP and age (p=0.007), with no differences between sexes (p=0.96). Patients younger than 55 years of age had a longer PFP than their older counterparts (p=0.005). Younger males had a significantly longer PFP than older males (p=0.021). However, this was not observed in the female cohort (p=0.09) or between the younger men and women (p=0.66).Conclusions: Our findings suggest that Stretta is a safe and feasible option for treating refractory GERD, especially in younger patients. It prevents further anti-reflux interventions in most patients and increases the lead-time to surgery in patients with refractory GERD.

Long-term efficacy of endoscopic radiofrequency Stretta therapy for patients with refractory gastroesophageal reflux disease

“…In this issue of Clinical Endoscopy, Joel et al 10 reported the clinical outcomes of the Stretta therapy in patients with refractory GERD. From October 2014 to June 2022, 195 patients underwent the Stretta therapy at a tertiary center in the United Kingdom.…”

Clinicians should be aware of proton pump inhibitor–related changes in the gastric mucosa

“…In particular, many patients with GERD (especially those with Barrett's esophagus) and individuals who use NSAIDs require long-term PPI therapy. [1][2][3] An important problem associated with long-term PPI therapy is hypergastrinemia secondary to the homeostatic response of antral G cells to decreased gastric acidity. Histopathologically, long-term PPI therapy induces protrusion of parietal cells into the lumen of glands, cystic dilatation of the fundic glands of the stomach, and hyperplasia of foveolar epithelial cells.…”