CONTEMPORARY STRETTA THERAPY FOR GASTROESOPHAGEAL REFLUX DISEASE IN THE MODERN DAY ERROR OF THE PPI CONCERNS, FRIEND OR FOE?

Aims:

Gastroesophageal reflux disease (GORD) is one of the leading gastrointestinal disorders, Patients with GORD often seek alternative therapy for inadequate symptom control, with over 40% not responding to medical treatment. Current treatments include lifestyle modifications, pharmacological therapies, surgical and STRETTA therapy that is a minimally invasive procedure that significantly reduces GORD symptoms, allowing the majority of patients to eliminate or decrease use of PPIs.

Methods:

A multi-center retrospective data collected from three Mediclinic Middle East centers in DubaiUAE on (75) patients, period Jan 2015 – Nov 2017. Most Patients evaluated had ambulatory 24-hour pH testing &previous gastroscopy for assessment of LOS. 3 patients had Previous Nissan fundoplication (NF) surgery and 1 had previous gastric bypass. Stretta uses radiofrequency (RF) energy delivered to the tissues of the distal lower Oesophageal sphincter (LOS) and gastric cardia, which decreases LOS compliance, increases LOS muscle mass, and limits the inappropriate transient LOS relaxations responsible for GORD. Patients were followed up 2 wks, 30 days, 3 months and one year.

Results:

Prior DeMeester score average of 54 – 99, with hypotensive LOS pressure. There was a small learning curve (45+/-7)min for the first 10 procedures; mild to moderate pain during the first 72 postoperative hours was controlled with paracetamol syrup. Two (2.5%) complications; one patient presented with ulcerative esophagitis 7 days after the Stretta treatment, and one patient developed pneumonia 5 days postoperatively. 50 patients (63%) were 50% on reduced PPI dose at two months and 61 patients (77%) were off treatment at 6 months and 70 patients (88%) at 12 months were off all antisecretory medication. The other five patients (6%) were on PRN PPI.

Conclusions:

In our study 88% of patients were off PPIs at one year. The rising concern of long-term side effects of the popular proton-pump inhibitors have prompted reinterest in endoscopic procedures for GORD and also economic significance as the costs of long-term pharmacological treatment are tremendous. STRETTA delivery significantly improved GORD symptoms with high efficacy and low complication rate endoscopic procedure. This procedure represents an excellent alternative for selected symptomatic gastroesophageal reflux disease patients who are intolerant of/or desire an alternative to, traditional medical therapies.