Stretta as the initial antireflux procedure in children.
BACKGROUND
The Stretta procedure is an endoluminal antireflux procedure using radio frequency to induce collagen tissue contraction, remodeling, and modulation of lower esophageal sphincter physiology in an effort to treat gastroesophageal reflux disease (GERD). Although Stretta has been widely reported in the adult GERD literature as a viable initial surgical option, similar use in children has not been reported. The authors present the first report of Stretta as the initial antireflux procedure in children with GERD, evaluating indications, safety, and efficacy.


METHODS
The charts of 8 children (aged 11-16 years) who received Stretta between January 2003 and September 2003 were retrospectively reviewed under an Institutional Review Board protocol. All patients had documented GERD preoperatively. Three children required concomitant feeding tube placement (percutaneous gastrostomy tube, group A). Five children with isolated severe GERD refractory to aggressive medical therapy received Stretta only (group B).


RESULTS
Stretta was successfully completed in all 8 children. In group A, 1 child developed a postoperative aspiration, which was successfully treated. All 3 children had resolution of their GERD symptoms (ie, feeding intolerance, emesis) and were able to tolerate full enteral nutrition post-Stretta. In group B, 3 of 5 children are currently off medications and asymptomatic on short-term follow-up (6-15 months). Of the remaining 2, 1 experienced symptomatic relief immediately postprocedure, but symptoms recurred off medications. Stretta was deemed unsuccessful in the remaining patient, and Nissen fundoplication was subsequently performed without difficulty.


CONCLUSIONS
Stretta can be safely and successfully used as the initial antireflux procedure for children with GERD. Concomitant Stretta with PEG is an attractive option in children with preexisting GERD who require long-term feeding access. Longer follow-up and a larger patient population are needed to better confirm the safety and efficacy of Stretta presented in this report.
Liu
Donald C
DC
University of Chicago Comer Children's Hospital, Chicago, IL 60637, USA. dliu@surgery.bsd.uchicago.edu
Somme
Stig
S
Mavrelis
Peter G
PG
Hurwich
Daniel
D
Statter
Mindy B
MB
Teitelbaum
Daniel H
DH
Zimmermann
Beth T
BT
Jackson
Carl-Christian A
CC
Dye
Charles
C
D000293:Adolescent; D017115:Catheter Ablation / Q000379:methods*; D002648:Child; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D012189:Retrospective Studies; D016896:Treatment Outcome