Clin Endosc.  2024 Jan;57(1):58-64. 10.5946/ce.2023.026.

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

• Joel A
• Konjengbam A
• Viswanath Y
• Kourounis G
• Hammond E
• Frank H
• Kuttuva S
• Mbarushimana S
• Hidayat H
• Thulasiraman S

• KMID: 2551193
• DOI: http://doi.org/10.5946/ce.2023.026

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.

Keyword

Fundoplication; Gastroesophageal reflux; Proton pump inhibitors; Radiofrequency treatment; Stretta

Figure

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  Fig. 1. Post-Stretta outcomes. (A) Box and whisker plot showing PFP between the sexes. (B) Scatterplot with a negative correlation between PFP and age. (C) Box and whisker plot showing PFP between younger (<55 years) and older (>55 years) patients from both sexes. (D) Box and whisker plot showing significantly higher PFP in the younger cohort of patients. PFP, proton pump inhibitor-free period. *p<0.05.

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