Stretta: a valuable endoscopic treatment modality for gastroesophageal reflux disease

Abstract

One potential option for the management of refractory gastro-esophageal reflux disease (GERD) is the delivery of radiofrequency energy to the gastro-esophageal junction (Stretta). This endoscopic therapy is safe, effective, durable, and repeatable if necessary and serves an unmet need for many GERD sufferers. Stretta could be effective in decreasing esophageal sensitivity to acid and in decreasing the gastro-esophageal junction compliance, which in turn contributes to symptomatic benefit by decreasing refluxate volume. Therefore, Stretta may serve as an endoscopic pain modulator and should be considered in patients with refractory symptoms despite proton pump inhibitors, as well as in patients with functional heartburn.

Keywords: Esophageal sphincter; Esophagitis; Gastroesophageal reflux disease; Heartburn; Lower; Radiofrequency energy.

Figures

Figure 1

Possible outcomes of proton pump inhibitor therapy in the primary care management of gastroesophageal reflux disease. PPI: Proton pump inhibitor.

Figure 2

Endoscopic appearance of the gastroesophageal junction immediately after Stretta. Antegrade view of the squamo-columnar junction (A); retrograde view of the cardia (B). White coagulation marks are seen circumferentially in both images.

Figure 3

Stretta is an adjunct in the treatment of gastroesophageal reflux disease that spans the “gap” between proton pump inhibitor responders and surgical candidates. PPI: Proton pump inhibitor; ARS: Anti-reflux surgery; “gap”: % of patients refractory to PPI not pursuing ARS.

Figure 4

Proposed algorithm for the management of patients with refractory gastroesophageal reflux disease. GERD: Gastroesophageal reflux disease; PPI: Proton pump inhibitor.