Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
권호 표지
DOI QR코드

DOI QR Code

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

  • Abraham Joel (Department of General and Upper Gastrointestinal Surgery, James Cook University Hospital) ;
  • Alakh Konjengbam (Department of General and Upper Gastrointestinal Surgery, James Cook University Hospital) ;
  • Yirupaiahgari Viswanath (Department of General and Upper Gastrointestinal Surgery, James Cook University Hospital) ;
  • Georgios Kourounis (Department of General and Upper Gastrointestinal Surgery, James Cook University Hospital) ;
  • Emily Hammond (Department of General and Upper Gastrointestinal Surgery, James Cook University Hospital) ;
  • Helen Frank (Department of General and Upper Gastrointestinal Surgery, James Cook University Hospital) ;
  • Shivani Kuttuva (Department of General and Upper Gastrointestinal Surgery, James Cook University Hospital) ;
  • Simon Mbarushimana (Department of General and Upper Gastrointestinal Surgery, James Cook University Hospital) ;
  • Hena Hidayat (Department of General and Upper Gastrointestinal Surgery, James Cook University Hospital) ;
  • Srivishnu Thulasiraman (Department of General and Upper Gastrointestinal Surgery, James Cook University Hospital)
  • Received : 2023.01.14
  • Accepted : 2023.02.08
  • Published : 2024.01.30
Download PDF
⟨ Previous Next ⟩

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.

Keywords

References

  1. Liang WT, Wang ZG, Wang F, et al. Long-term outcomes of patients with refractory gastroesophageal reflux disease following a minimally invasive endoscopic procedure: a prospective observational study. BMC Gastroenterol 2014;14:178.
  2. El-Serag HB, Sweet S, Winchester CC, et al. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 2014;63:871-880.
  3. Peery AF, Crockett SD, Murphy CC, et al. Burden and cost of gastrointestinal, liver, and pancreatic diseases in the United States: update 2018. Gastroenterology 2019;156:254-272.
  4. Shaheen NJ, Hansen RA, Morgan DR, et al. The burden of gastrointestinal and liver diseases, 2006. Am J Gastroenterol 2006;101:2128-2138.
  5. Patti MG. An evidence-based approach to the treatment of gastroesophageal reflux disease. JAMA Surg 2016;151:73-78.
  6. Ma L, Li T, Liu G, et al. Stretta radiofrequency treatment vs Toupet fundoplication for gastroesophageal reflux disease: a comparative study. BMC Gastroenterol 2020;20:162.
  7. Hershcovici T, Fass R. Pharmacological management of GERD: where does it stand now? Trends Pharmacol Sci 2011;32:258-264.
  8. Naik RD, Meyers MH, Vaezi MF. Treatment of refractory gastroesophageal reflux disease. Gastroenterol Hepatol (N Y) 2020;16:196-205.
  9. Fass R, Cahn F, Scotti DJ, et al. Systematic review and meta-analysis of controlled and prospective cohort efficacy studies of endoscopic radiofrequency for treatment of gastroesophageal reflux disease. Surg Endosc 2017;31:4865-4882.
  10. Rodriguez de Santiago E, Sanchez-Vegazo CT, Penas B, et al. Antireflux mucosectomy (ARMS) and antireflux mucosal ablation (ARMA) for gastroesophageal reflux disease: a systematic review and meta-analysis. Endosc Int Open 2021;9:E1740-E1751.
  11. Rettura F, Bronzini F, Campigotto M, et al. Refractory gastroesophageal reflux disease: a management update. Front Med (Lausanne) 2021;8:765061.
  12. He S, Xu F, Xiong X, et al. Stretta procedure versus proton pump inhibitors for the treatment of nonerosive reflux disease: a 6-month follow-up. Medicine (Baltimore) 2020;99:e18610.
  13. Funk LM, Zhang JY, Drosdeck JM, et al. Long-term cost-effectiveness of medical, endoscopic and surgical management of gastroesophageal reflux disease. Surgery 2015;157:126-136.
  14. Lee DP, Chang KJ. Endoscopic management of GERD. Dig Dis Sci 2022;67:1455-1468.
  15. Nevins EJ, Dixon JE, Viswanath YK. The outcome of endoscopic radiofrequency anti-reflux therapy (STRETTA) for gastroesophageal reflux disease in patients with previous gastric surgery: a prospective cohort study. Clin Endosc 2021;54:542-547.
  16. Utley DS. The Stretta procedure: device, technique, and pre-clinical study data. Gastrointest Endosc Clin N Am 2003;13:135-145.
  17. Noar MD, Lotfi-Emran S. Sustained improvement in symptoms of GERD and antisecretory drug use: 4-year follow-up of the Stretta procedure. Gastrointest Endosc 2007;65:367-72.
  18. Arts J, Bisschops R, Blondeau K, et al. A double-blind sham-controlled study of the effect of radiofrequency energy on symptoms and distensibility of the gastro-esophageal junction in GERD. Am J Gastroenterol 2012;107:222-230.
  19. Viswanath Y, Maguire N, Obuobi RB, et al. Endoscopic day case antireflux radiofrequency (Stretta) therapy improves quality of life and reduce proton pump inhibitor (PPI) dependency in patients with gastro-oesophageal reflux disease: a prospective study from a UK tertiary centre. Frontline Gastroenterol 2019;10:113-119.
  20. Jung HK, Tae CH, Song KH, et al. 2020 Seoul Consensus on the diagnosis and management of gastroesophageal reflux disease. J Neurogastroenterol Motil 2021;27:453-481.
  21. Triadafilopoulos G. Stretta: a valuable endoscopic treatment modality for gastroesophageal reflux disease. World J Gastroenterol 2014;20:7730-7738.
  22. Jung HY. In which situation is endoscopic radiofrequency anti-reflux therapy (Stretta) effective for controlling gastroesophageal reflux symptoms? Clin Endosc 2021;54:451-452.
  23. Utley DS, Kim M, Vierra MA, et al. Augmentation of lower esophageal sphincter pressure and gastric yield pressure after radiofrequency energy delivery to the gastroesophageal junction: a porcine model. Gastrointest Endosc 2000;52:81-86.
  24. Kim MS, Holloway RH, Dent J, et al. Radiofrequency energy delivery to the gastric cardia inhibits triggering of transient lower esophageal sphincter relaxation and gastroesophageal reflux in dogs. Gastrointest Endosc 2003;57:17-22.
  25. Chen D, Barber C, McLoughlin P, et al. Systematic review of endoscopic treatments for gastro-oesophageal reflux disease. Br J Surg 2009;96:128-136.
  26. Liu HF, Zhang JG, Li J, et al. Improvement of clinical parameters in patients with gastroesophageal reflux disease after radiofrequency energy delivery. World J Gastroenterol 2011;17:4429-4433.
  27. Perry KA, Banerjee A, Melvin WS. Radiofrequency energy delivery to the lower esophageal sphincter reduces esophageal acid exposure and improves GERD symptoms: a systematic review and meta-analysis. Surg Laparosc Endosc Percutan Tech 2012;22:283-288.
  28. Triadafilopoulos G, DiBaise JK, Nostrant TT, et al. The Stretta procedure for the treatment of GERD: 6 and 12 month follow-up of the U.S. open label trial. Gastrointest Endosc 2002;55:149-156.
  29. Corley DA, Katz P, Wo JM, et al. Improvement of gastroesophageal reflux symptoms after radiofrequency energy: a randomized, sham-controlled trial. Gastroenterology 2003;125:668-676.
  30. Coron E, Sebille V, Cadiot G, et al. Clinical trial: radiofrequency energy delivery in proton pump inhibitor-dependent gastro-oesophageal reflux disease patients. Aliment Pharmacol Ther 2008;28:1147-1158.
  31. Aziz AM, El-Khayat HR, Sadek A, et al. A prospective randomized trial of sham, single-dose Stretta, and double-dose stretta for the treatment of gastroesophageal reflux disease. Surg Endosc 2010;24:818-825.
  32. Dughera L, Rotondano G, De Cento M, et al. Durability of stretta radiofrequency treatment for GERD: results of an 8-year follow-up. Gastroenterol Res Pract 2014;2014:531907.
  33. Noar M, Squires P, Noar E, et al. Long-term maintenance effect of radiofrequency energy delivery for refractory GERD: a decade later. Surg Endosc 2014;28:2323-2333.
  34. De Giorgi F, Palmiero M, Esposito I, et al. Pathophysiology of gastro-oesophageal reflux disease. Acta Otorhinolaryngol Ital 2006; 26:241-246.
  35. Becher A, Dent J. Systematic review: ageing and gastro-oesophageal reflux disease symptoms, oesophageal function and reflux oesophagitis. Aliment Pharmacol Ther 2011;33:442-454.
  36. Gerstein AD, Phillips TJ, Rogers GS, et al. Wound healing and aging. Dermatol Clin 1993;11:749-757.