Surgery alone may not be a curative treatment for GISTs. Targeted therapy with imatinib may play an important role in the treatment of GISTs. Further risk categorisation models may be needed to evaluate GIST behaviour and prognosis.

BackgroundEndoscopic antireflux radiofrequency treatment (Stretta) offers a therapeutic alternative for patients suffering from refractory gastro-oesophageal reflux disease (GORD). Current evidence suggests that the treatment may improve symptoms of GORD and decrease requirement for proton pump inhibitor (PPI) therapy.MethodsProspective assessment of patients undergoing Stretta, between October 2014 and February 2016, in a UK tertiary referral centre was carried. All patients were assessed for suitability using endoscopy, contrast studies, and pH and manometry studies. The Gastro-oesophageal Reflux Disease-Health-Related Quality of Life (GERD-HRQL) was used to evaluate symptoms along with PPI dependency, pre-Stretta and post-Stretta treatment. Patients were followed up by outpatient clinic appointment and telephone consultation.ResultsFifty consecutive patients were followed up for a median of 771 days (range 499–1162) following treatment with Stretta. The average GERD-HRQL score improved from 46.2/75 (±14.2) preprocedure to 15.2/75 (±17.3) postprocedure. Dissatisfaction with GORD as measured in the GERD-HRQL decreased from 100% to 10% with three patients showing no improvement (non-responders) at follow up and two late failures at the time of this review. There were no complications and all cases were carried out as day cases.ConclusionThere are currently few effective therapeutic alternatives to antireflux surgery for refractory GORD. This series corroborates the value and safety of Stretta as a viable option for selected patients who are unwilling or unable to undergo an operation. Stretta improves quality of life and decreases PPI dependency in selected patients with GORD.

IntroductionGastro-oesophageal reflux disease (GORD) is usually treated with lifestyle modifications, combined with drug therapy (antacids, alginates and acid suppression drugs such as proton pump inhibitors and H2 receptor antagonists). Patients with inadequate response to lifestyle and medical treatments, or intolerant of medical therapy, are offered anti-reflux surgery with open or laparoscopic fundoplication which remains the gold standard.1,2 Stretta® is a minimally-invasive endoscopic treatment that delivers non-ablative radiofrequency (NARF) energy to improve and restore the function of the lower oesophageal sphincter muscle, thereby improving symptoms of GORD. The efficacy of the Stretta® procedure in achieving symptom control of GORD has been reported in previous international publications. A systematic review involving 20 studies with 1441 patients having a mean follow-up interval of 15 months showed significant improvements in GORD symptoms including disease-specific and global quality of life.3 UK data on the outcomes of Stretta® have not been reported, and this is the first report of the Stretta® procedure in the UK, carried out at a single centre since October 2014.MethodsPatients with confirmed GORD, unresponsive to medical management with standard or double dose PPI, were offered the Stretta ®procedure based on clinician and patient shared decision. Patients with an associated hiatus hernia of ≤2 cm on their index endoscopy were included. Patients needed to be symptomatic of reflux for at least 3 months on medication and all patients were administered a GERD Health Related Quality of Life (GERD-HRQL) questionnaire pre- and post-Stretta® procedure. The Stretta ® procedure was carried out either under general anaesthesia (early phase) or conscious sedation (later phase) by a single trained endoscopist using the manufacturers protocol. Up to 14 lesion sets or 56 RF applications to the LOS at 1 cm intervals were carried out using an automated generator (Mederi Therapeutics Inc, USA).Results26 patients underwent the Stretta procedure over a period of 12 months (October 2014 - September 2015).The mean follow-up period was 3.8 months (range 10.5) and there were no recorded procedural complications. All patients completed pre and post procedure GERD-HRQL questionnaires. The median heartburn score (scale 0–30) improved from 18 pre-procedure to 2.5 post-procedure. The overall median regurgitation score (scale 0–30) improved from 19 pre-procedure to 0 post procedure. The overall patient satisfaction was 78%. There was also an improvement in the median overall total GERD-HRQL score (scale 0–75) from 44 pre-procedure to 6 post-procedure. 3 patients had undergone previous anti-reflux surgery. There was again overall improvement of median heartburn scores (18 pre, 0 post), regurgitation scores (1 pre, 0 post) and total GERD-HRQL scores (27 pre, 0 post).Baseline and post-procedure GERD-HRQLscores in 27 patients, average follow-up of 3.8 months:Abstract PWE-087 Table 1Outcome variablesPre-StrettaPost-StrettaHeartbu...