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Stretta


The Stretta procedure uses radio frequency energy bursts to tighten the lower oesophageal sphincter to help it function correctly.
The manufacturers state, "We do not position Stretta as competitive treatment with surgery – but instead a less invasive bridge that allows some patients for whom medications are not completely effective to avoid surgery and its potential complications, or if someone has had surgery allows them an option other than additional surgery."

From the manufacturer's (Mederi Therapeutics) own website, www.stretta-therapy.com:

When patients suffer from chronic gastroesophageal reflux disease (GERD) that is not well controlled with medications, or where long-term medications are not a viable option, Stretta offers an alternative other than surgery and implants. Stretta is a unique and minimally invasive outpatient procedure that takes about an hour, with patients returning to normal activities within a few days.

  • Studies show that Stretta resolves reflux symptoms and improves quality of life
  • Stretta reduces or eliminates medications and reduces acid exposure
  • A minimally invasive option that is less aggressive than invasive surgery and implants
  • More than 33 clinical studies all conclude Stretta is "safe and effective"
  • Stretta results are long-lasting, proven effective from 4-10 years
  • Treats the underlying cause of GERD not just the symptoms

Stretta is an important part of the continuum of care for patients with chronic GERD and is the ideal "middle therapy" fitting between medicine and surgery, yet not preventing a patient from moving on to more invasive options in the future if necessary.

A 10 year follow-up report of patients who had received Stretta therapy published in Surgical Endoscopy February 2014 [r-xii] showed  "72 % of patients normalizing GERD symptom scores, 41 % of patients able to remain off regular medication for GERD, 64 % of patients able to reduce medication use by 50 % or greater, and more than 60 % sustained improvement in satisfaction."

In the USA, SAGES (Society of American Gastrointestinal and Endoscopic Surgeons) guidelines issued June 2013 [r-xiii] recommended "Stretta is considered appropriate therapy for patients being treated for GERD who are 18 years of age or older, who have had symptoms of heartburn, regurgitation, or both for 6 months or more, who have been partially or completely responsive to anti-secretory pharmacologic therapy, and who have declined laparoscopic fundoplication."

Stretta may be recommended as an appropriate therapeutic option for patients with GERD who meet current indications and patient selection criteria and choose endoluminal therapy over laparoscopic fundoplication. Those criteria include:

Adult patients (age >=18) with symptoms of heartburn, regurgitation, or both for >= 6 months who have been partially or completely responsive to antisecretory pharmacologic therapy.

The procedure has not been studied and should not be applied in treating patients with severe esophagitis, hiatus hernias > 2 cm, long segment Barrett esophagus, dysphagia, or those with a history of autoimmune disease, collagen vascular disease, and/or coagulation disorders.  Further studies are needed to evaluate the role of Stretta in children if it is to be considered a therapeutic option.

In UK, NICE have yet to rule on it's use. "NICE has been notified about the above procedure and are currently undertaking preliminary investigations, with the aim of assessing whether this procedure falls within the remit of the Interventional Procedures Programme."

N.B. This procedure is not to be confused with Radio Frequency Ablation.

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