Radiofrequency energy delivery to the gastric cardia inhibits triggering of transient lower esophageal sphincter relaxation in a canine model

First year experience of patients undergoing the stretta procedure

“…Kim and associates [5] reported a 54% reduction in tLESRs following RF delivery in a canine model, while Dibaise et al [2] found a similar reduction in humans.…”

Delivery of radiofrequency energy to the gastroesophageal junction (Stretta procedure) for the treatment of gastroesophageal reflux disease

“…Human and animal studies suggest that RF energy may decrease GERD symptoms by decreasing the frequency of transient LES relaxations associated with reflux episodes, increasing the intragastric pressure needed to induce reflux, and hastening gastric emptying [8,20,23,24]. Another potential mechanism of the improved symptoms is decreased visceral sensitivity, as witnessed by the observation that the time needed to report symptoms during esophageal acid perfusion was significantly longer 6 months after a Stretta procedure compared with baseline [1].…”

“…Although neurolysis with impairment of sensory afferent pathways is indeed a potential mechanism, other factors may include esophageal exposure to hydrogen ions, mucosal permeability, number and activation state of acid-sensitive nerve endings, and central processing of incoming sensory information. RF energy delivery may influence several of these mechanisms as well as the compliance of the gastroesophageal junction, increasing the resistance of the LES to a distending pressure [8] and decreasing the volume of refluxate during relaxations of the LES. Like all other published studies of RF treatment, the current study excluded patients with large hiatal hernias, erosive esophagitis despite medical treatment, BarrettÕs esophagus, or primarily extraesophageal manifestations of GERD (e.g., asthma); such patients should not be treated outside of research protocols.…”

Innovations in Gastro-Intestinal Endoscopy: Endoscopic Antireflux Therapies for Gastro-Oesophageal Reflux Disease

“…However, the preliminary results using radio frequency techniques have shown a significant reduction in the frequency of TLOSRs in an experimental setting in a canine model [60] and in humans [61], suggesting that partial denervation is a possible mechanism of action. It failed to show significant improvement in LOS pressure [58,59], but did show improvement in gastric emptying [62].…”

“…It failed to show significant improvement in LOS pressure [58,59], but did show improvement in gastric emptying [62]. After administration of radiofrequency, an increased muscle wall thickness has been shown in an animal model [60,63], but not in humans [58].…”