Use of radiofrequency ablation of the lower esophageal sphincter to treat recurrent gastroesophageal reflux disease.
OBJECTIVE
Recurrent gastroesophageal reflux disease (GERD) after gastroesophageal surgery is a troublesome problem. Reoperative surgery often is complicated by adhesions and recurrence. Radiofrequency ablation or energy delivery (RF or the Stretta procedure) is a new method for treating GERD. This study is the first report describing the use of the Stretta procedure in pediatric patients.


METHODS
Six patients who underwent previous gastroesophageal surgery presented with recurrent GERD. Medical records were reviewed and the severity of reflux graded using a modified scoring system. All underwent RF and were graded for GERD at 6 months postprocedure.


RESULTS
Mean operating time was 80 +/- 12 minutes. Mean age at initial operation was 12 +/- 4 years and for the RF, 18.0 +/- 3.4 years. All patients were discharged as outpatients. Early complications occurred in one child with self-resolving acute gastric distension. Five of 6 patients were completely asymptomatic at 3 months after the procedure, and 3 stopped anti secretory agents. One patient was improved but still symptomatic and needed a redo fundoplication. Another required a repeat application of RF 10 months after the initial one. Mean GERD score pre-Stretta was 5.2 +/- 1.0, which improved to 1.6 +/- 1.9 at 6 months postprocedure (P <.05; paired t test).


CONCLUSIONS
Use of RF treatment of the lower esophageal sphincter is a potentially successful modality to treat recurrent GERD in children. Long-term follow-up is required.
Islam
Saleem
S
Section of Pediatric Surgery, CS Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI 48109, USA.
Geiger
James D
JD
Coran
Arnold G
AG
Teitelbaum
Daniel H
DH
D000293:Adolescent; D017115:Catheter Ablation / Q000295:instrumentation / Q000379:methods*; D002648:Child; D004943:Esophagogastric Junction / Q000601:surgery*; D020701:Esophagoscopes; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D008297:Male; D000078702:Radiofrequency Therapy; D012189:Retrospective Studies; D055502:Secondary Prevention; D016896:Treatment Outcome