The Outcome of Endoscopic Radiofrequency Anti-Reflux Therapy (STRETTA) for Gastroesophageal Reflux Disease in Patients with Previous Gastric Surgery: A Prospective Cohort Study

Abstract

INTRODUCTION Endoscopic radiofrequency therapy for gastro-esophageal reflux disease (GERD) has been proven to be successful. 1 STRETTA is the only radiofrequency device licensed for this indication in the UK and is approved by The National Institute for Health and Care Excellence (NICE) for cases refractory to medical therapy. 2 STRETTA improves the quality of life and reduces the need for anti-reflux medication in a select group of patients, 3 namely those with uncomplicated GERD. Complicated GERD is defined as the presence of stenotic disease, ulcerative esophagitis, scarring of the gastro-esophageal junction (GEJ), a recurrent hiatus hernia of > 2.5 cm, a dilated crura of > 2.5 cm, Barrett's metaplasia, wrap migration, and gastric volvulus. 4 At our center, STRETTA is not performed on patients with complicated GERD. STRETTA has also been shown to be cost-effective in some studies. 5 For refractory GERD in patients with a history of previous gastric surgery, STRETTA is effective; however, it has been reported only in a few studies. A retrospective study of 6 patients with a history of previous Roux-en-Y gastric bypass showed that STRETTA led to resolution of the symptoms in

Endoscopic Treatment of GERD in Patients With Obesity

“…In a small cohort study including 7 patients with a history of TIF and who were followed for 23 months, the reflux symptoms significantly improved in all patients following Stretta. 27 Three patients discontinued their PPI, while 3 others were on a reduced dose. Only 1 patient did not discontinue or reduce the PPI usage, but did not require H2RB anymore.…”

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

“…14 Stretta is the only RF device licenced by the National Institute for Health and Care Excellence for use in the UK for refractory GERD. 15 It uses a balloon-tipped four-needle catheter to deliver RF to the LES while irrigating the mucosa to prevent heat injury. 1 The safety, short-and long-term efficacy, reduction in PPI dependency, improvement in the QOL, and patient satisfaction with Stretta have been evaluated multiple times with mixed results.…”

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

“…5 In this study, reflux symptoms of almost all the patients (6/7) improved after Stretta. 6 Stretta was also effective for the patients who had undergone other surgeries such as fundal gastrointestinal stromal tumor resection and vagotomy with pyloroplasty. Because these surgeries do not affect the GEJ anatomy, GERD symptoms were successfully controlled with Stretta.…”