In Which Situation is Endoscopic Radiofrequency Anti-Reflux Therapy (Stretta) Effective for Controlling Gastroesophageal Reflux Symptoms?

Abstract

Endoscopic radiofrequency anti-reflux therapy (Stretta) is a minimally invasive mechanical therapy for gastroesophageal reflux disease (GERD) and it targets the intrinsic components of the gastroesophageal junction (GEJ). 1 The components of GEJ are the lower esophageal sphincter (LES, intrinsic sphincter) and the surrounding structures, including the crural diaphragm, esophagophrenic ligaments, and connective tissues, which form the extrinsic sphincter. 2 Moderate heat, ranging from 80-90 o C, denatures muscle fibers at the tip of the catheter, and enables injured muscle fibers to regenerate through the remodeling process. The remodeling process induces hypertrophic changes in the muscle fibers and results in the augmentation of barrier function. Stretta therapy increases LES pressure and decreases LES compliance, resulting in decreased reflux, which enhances the quality of life. 3 Because the extrinsic barrier function of GEJ is lost in larger hiatal hernias measuring > 2 cm, the effect of Stretta would be limited in cases of hiatal hernia. The diagnosis of hiatal hernia

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

“…14 A sub-ablative application of thermal RF energy denatures muscle fibers, which subsequently regenerate through the remodelling process, inducing muscular hypertrophy and strengthening the LES. 22 Other studies have suggested an effect on the neuromuscular function of the LES. In a preclinical trial, a group investigating the impact of Stretta on LES pressure after the injection of botulinum toxin to LES identified a significant increase in the LES pressure in the Stretta group compared with the placebo.…”

“…Of these, Stretta is the only procedure that does not result in structural changes within the lumen and does not affect future surgery. 22 Although there are several theories, it remains unclear how Stretta produces an effect. 14 A sub-ablative application of thermal RF energy denatures muscle fibers, which subsequently regenerate through the remodelling process, inducing muscular hypertrophy and strengthening the LES.…”

Endoscopic Management Options for Gastroesophageal Reflux Disease

“…Patients who wish to be off long-term PPI medications and prefer the least invasive option would be suitable candidates for Stretta. Poor candidates for Stretta include patients with large hiatal hernia (greater than 2 cm), significant dysphagia (with evidence of spastic motility disorder on esophageal manometry), and severe esophagitis [ 3 ].…”