Delivery of radiofrequency energy to the lower esophageal sphincter improves symptoms of gastroesophageal reflux.
BACKGROUND
The Stretta procedure has been proposed as a novel therapeutic alternative to antireflux surgery for gastroesophageal reflux disease (GERD). Early reports indicated improvement in GERD symptoms overall, but improvement in patients who have poor outcome after surgery remains unclear.


METHODS
Patients with reflux who did not have a hiatal hernia were offered the procedure. All were administered a GERD Health Related Quality of Life survey at preprocedure and at greater than 3 months postprocedure. Differences in pre- and postprocedure responses were deemed significant with the use of the Wilcoxon rank sum test with P <.05.


RESULTS
Fifty patients underwent the Stretta procedure. There were no complications. All were evaluated postprocedure, with 74% completing a postprocedure survey. Overall heartburn score improved from 3.19 (scale, 0-5) preprocedure to 1.74 postprocedure (P=.0012). Overall symptoms satisfaction score improved from 3.92 to 1.63 (P=.0001). Symptoms satisfaction score of patients who failed antireflux surgery improved from 3.5 to 1.75 (P=.0166), and, in those with a body mass index >30, it improved from 4.11 to 1.56 (P=.0024). Four patients went on to have antireflux surgery after having the Stretta procedure.


CONCLUSIONS
Stretta improves heartburn symptoms both overall and in patients with poor outcome after antireflux surgery, with a low procedural risk. It may have a role in the treatment of patients with primary reflux and in those who have failed antireflux surgery or who are a high risk for surgery.
Department of Surgery, The Ohio State University Medical Center, Columbus, Ohio 43210, USA.
Michael R
MR
Go
John M
JM
Dundon
Dianne J
DJ
Karlowicz
Carlos B
CB
Domingo
Peter
P
Muscarella
W Scott
WS
Melvin
D000328:Adult; D000368:Aged; D017115:Catheter Ablation / Q000379:methods*; D016145:Endoscopy, Digestive System; D004943:Esophagogastric Junction / Q000528:radiation effects; D004945:Esophagoscopy; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000628:therapy*; D006356:Heartburn / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D016896:Treatment Outcome