Among patients with a history of gastric surgery, STRETTA, a radiofrequency device, may successfully reduce refractory gastroesophageal reflux disease (GERD), according to research published in Clinical Endoscopy.
STRETTA is the only endoscopic radiofrequency therapy device indicated in the UK for GERD, and has been approved by The National Institute for Health and Care Excellence. Although STRETTA is reported to be effective for refractory GERD in patients with prior gastric surgery, studies supporting this are limited.
A team of investigators conducted a prospective cohort study to review outcomes of STRETTA in this patient population.
Of the 196 patients who underwent STRETTA since 2016, 11 of these patients had previous gastric surgery and were included in the analysis. The median follow-up was 23 months, 9 of these patients had improved GERD-health-related quality of life scores (82%), and 3 of these patients did not require additional antireflux medication.
Prior to STRETTA, all 11 patients were treated with proton pump inhibitors (PPIs); 5 patients discontinued PPI use and 3 patients reduced PPI dose following STRETTA.
The most commonly reported intervention was laparoscopic Nissen fundoplication (n=7). However, all patients who underwent fundoplication reported symptom improvement after STRETTA. Of the 7 patients, 3 patients discontinued medication and 3 patients had a reduced dose of PPI. Although 1 patient did not discontinue or reduce PPI treatment following STRETTA in this subgroup, this patient no longer required H2-receptor antagonist medication.
A total of 4 patients underwent previous gastric surgery other than fundoplication. One patient underwent esophyx and 2 further revisional antireflux surgeries, a single patient underwent gastrointestinal stromal tumor resection (GIST), another patient underwent roux-en-Y gastric bypass, and the last patient underwent vagotomy and pyloroplasty. The patients who underwent GIST and vagotomy/pyloroplasty saw improved outcomes following STRETTA and discontinued PPI medication, while the other 2 patients did not see improvement.
“[T]his case series demonstrates that STRETTA is successful in reducing refractory GERD in patients with a history of gastric surgery. The outcomes in this cohort of patients were comparable to published outcomes in patients with uncomplicated GERD who have not previously undergone a gastric intervention,” concluded the investigators.
Nevins EJ, Dixon JE, Viswanath YKS. The outcome of endoscopic radiofrequency anti-reflux rherapy (STRETTA) for gastro-esophageal reflux disease in patients with previous gastric surgery: a prospective cohort study. Clin Endosc. Published online March 24, 2021. doi: 10.5946/ce.2020.243