Radiofrequency energy delivery to the lower esophageal sphincter improves gastroesophageal reflux patient-reported outcomes in failed laparoscopic Nissen fundoplication cohort

Noar, Mark D.; Squires, Patrick; Khan, Sulman

doi:10.1007/s00464-016-5296-9

Cited by 35 publications

(18 citation statements)

References 28 publications

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“…In terms of the comparison of Stretta vs. fundoplication, two non-randomized prospective comparative studies have been published, but the methodology of these studies was flawed (with selection criteria differing in the two groups) and the definitions of end points and symptom measurements were heterogeneous [54,55]. However, some improvement in symptom scores was observed in both studies, while another prospective study of Stretta as rescue therapy after failed laparoscopic fundoplication also proved useful in a subset of patients [56].…”

Section: Radiofrequency Energy Application To the Les (Stretta)mentioning

confidence: 99%

Endoscopic management of gastrointestinal motility disorders – part 2: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2020

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Main RecommendationsESGE suggests flexible endoscopic treatment over open surgical treatment as first-line therapy for patients with a symptomatic Zenker’s diverticulum of any size.Weak recommendation, low quality of evidence, level of agreement 100 %.ESGE recommends that emerging treatments for Zenker’s diverticulum, such as Zenker’s peroral endoscopic myotomy (Z-POEM) and tunneling, be considered as experimental; these treatments should be offered in a research setting only.Strong recommendation, low quality of evidence, level of agreement 100 %.ESGE recommends against the widespread clinical use of transoral incisionless fundoplication (TIF) as an alternative to proton pump inhibitor (PPI) therapy or antireflux surgery in the treatment of gastroesophageal reflux disease (GERD), because of the lack of data on the long-term outcomes, the inferiority of TIF to fundoplication, and its modest efficacy in only highly selected patients. TIF may have a role for patients with mild GERD who are not willing to take PPIs or undergo antireflux surgery.Strong recommendation, moderate quality of evidence, level of agreement 92.8 %.ESGE recommends against the use of the Medigus ultrasonic surgical endostapler (MUSE) in clinical practice because of insufficient data showing its effectiveness and safety in patients with GERD. MUSE should be used in clinical trials only.Strong recommendation, low quality evidence, level of agreement 100 %.ESGE recommends against the use of antireflux mucosectomy (ARMS) in routine clinical practice in the treatment of GERD because of the lack of data and its potential complications.Strong recommendation, low quality evidence, level of agreement 100 %.ESGE recommends endoscopic cecostomy only after conservative management with medical therapies or retrograde lavage has failed.Strong recommendation, low quality evidence, level of agreement 93.3 %.ESGE recommends fixing the cecum to the abdominal wall at three points (using T-anchors, a double-needle suturing device, or laparoscopic fixation) to prevent leaks and infectious adverse events, whatever percutaneous endoscopic cecostomy method is used.Strong recommendation, very low quality evidence, level of agreement 86.7 %.ESGE recommends considering endoscopic decompression of the colon in patients with Ogilvie’s syndrome that is not improving with conservative treatment.Strong recommendation, low quality evidence, level of agreement 93.8 %.ESGE recommends prompt endoscopic decompression if the cecal diameter is > 12 cm and if the Ogilvie’s syndrome exists for a duration of longer than 4 – 6 days.Strong recommendation, low quality evidence, level of agreement 87.5 %.

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Section: Radiofrequency Energy Application To the Les (Stretta)mentioning

confidence: 99%

Endoscopic management of gastrointestinal motility disorders – part 2: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2020

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“…Endoscopic options remain attractive for patients, surgeons and gastroenterologists as they avoid the requirement for general anaesthetic, risks of abdominal surgery and postfundoplication complaints such as dysphagia and gas bloat. Stretta also offers an alternative to re-do fundoplication following failed Nissen’s18 and a potential alternative to further surgery in patients with obesity suffering from reflux following sleeve gastrectomy 19…”

Section: Discussionmentioning

confidence: 99%

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

Viswanath

Maguire

Dhar

et al. 2018

Frontline Gastroenterol

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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.

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“…The treatment for GERD includes a wide range of management strategies, from lifestyle changes to pharmacological, endoscopic, and surgical interventions (4,5,6) . When patients with GERD have persistent symptoms that are not controlled with drugs or when they are responders who do not wish to keep taking medication on a daily basis, the Stretta procedure is an alternative to surgery and implants.…”

Section: Discussionmentioning

confidence: 99%

“…Two mechanisms may explain the results obtained with the use of the Stretta procedure: improvement of GEJ tone through the retraction and deposition of collagen at the lesion sites and the neurolysis of fibers afferent to the GEJ that are responsible for the transient relaxation of the LES, which may reduce the episodes of transient sphincter relaxation and affect the fibers responsible for heartburn complaints (9)(10)(11)(12)(13) .…”

Section: Discussionmentioning

confidence: 99%

Short-Term Results of Minimally Invasive Treatment of Gastroesophageal Reflux Disease by Radiofrequency (Stretta): First Brazilian Series of Cases

Souza

Grecco

Quadros

et al. 2018

Arq. Gastroenterol.

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BACKGROUND: New endoscopic treatments for gastroesophageal reflux (GERD) are developed every year and are indicated in cases that are refractory to conventional therapies as well as after surgical treatment failure. OBJECTIVE: To present the first cases of endoscopic therapy for GERD performed in Brazil. METHODS: Use of radiofrequency with the Stretta procedure in symptomatic volunteers diagnosed with GERD. RESULTS The technique was performed in three patients after they were included in the study protocol. No patient had complications, and all patients were discharged on the same day, either without medication or taking it sporadically for symptom control. CONCLUSION: Endoscopic treatment for GERD using radiofrequency was effective in the cases presented herein with no technical complications.

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Radiofrequency energy delivery to the lower esophageal sphincter improves gastroesophageal reflux patient-reported outcomes in failed laparoscopic Nissen fundoplication cohort

Cited by 35 publications

References 28 publications

Endoscopic management of gastrointestinal motility disorders – part 2: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Endoscopic management of gastrointestinal motility disorders – part 2: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

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

Short-Term Results of Minimally Invasive Treatment of Gastroesophageal Reflux Disease by Radiofrequency (Stretta): First Brazilian Series of Cases

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