Abstract
Purpose of Review
Gastroesophageal reflux disease (GERD) is very common in the general population and poses a large societal socio-economic burden. In this article, we review the evidence supporting non-ablative radiofrequency treatment (Stretta) for the endoscopic management of GERD and we compare it to pharmacologic and other minimally invasive and surgical interventions.
Recent Findings
Proton pump inhibitors (PPI) are a key therapy for GERD. For patients without associated significant sliding hiatal hernia, who have inadequate relief of their reflux symptoms, Stretta and other endoscopic therapies, such as transoral fundoplication (TIF), may improve symptoms and GERD-related quality of life. Unfortunately, there are no recent large randomized controlled trials, and most of the evidence is based on meta-analyses and small scale, prospective and retrospective single center efforts. Comparisons of Stretta efficacy to other anti-reflux endoscopic modalities and anti-reflux surgery (ARS) are also presented.
Summary
There are several endoscopic and minimally invasive modalities to manage PPI-refractory GERD acting through various mechanisms that have been found effective in managing GERD symptoms and quality of life. Among them, Stretta has the longest track record of efficacy and safety. Larger-scale and longer-term comparative efficacy trials in selected populations of patients with acid reflux with and without hiatal hernia will be needed.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
•• Slater BJ, Collings A, Dirks R, Gould JC, Qureshi AP, Juza R, Rodríguez-Luna MR, Wunker C, Kohn GP, Kothari S, Carslon E, Worrell S, Abou-Setta AM, Ansari MT, Athanasiadis DI, Daly S, Dimou F, Haskins IN, Hong J, Krishnan K, Lidor A, Litle V, Low D, Petrick A, Soriano IS, Thosani N, Tyberg A, Velanovich V, Vilallonga R, Marks JM. Multi-society consensus conference and guideline on the treatment of gastroesophageal reflux disease (GERD). Surg Endosc. 2022. https://doi.org/10.1007/s00464-022-09817-3. This conference identified and addressed proper preoperative evaluation, endoscopic vs surgical or medical therapy, complete vs partial fundoplication, and treatment of patients with GERD and obesity.
•• Vaezi MF, Shaheen NJ, Muthusamy VR. State of evidence in minimally invasive Management of Gastroesophageal Reflux: findings of a scoping review. Gastroenterology. 2020;159(4):1504–25. https://doi.org/10.1053/j.gastro.2020.05.097. Authoritative review suggesting that the endoluminal and minimally invasive surgical interventions for GERD are promising alternatives to PPI therapy.
•• Zhang LY, Canto MI. Endoscopic approaches to gastroesophageal reflux disease. Curr Opin Gastroenterol. 2021;37(5):441–8. https://doi.org/10.1097/MOG.0000000000000759. Expansive review of endoscopic therapies bridging the gap between medical and surgical therapy for patients unwilling or unable to continue PPI indefinitely.
Richardson WS, Gorham JK, Neal N, Fanelli RD. Endoscopic treatment of Gastroesophageal reflux disease. Adv Surg. 2022 Sep;56(1):205–27. https://doi.org/10.1016/j.yasu.2022.04.001.
Sowa P, Samarasena JB. Nonablative radiofrequency treatment for Gastroesophageal reflux disease (Stretta). Gastrointest Endosc Clin N Am. 2020;30(2):253–65. https://doi.org/10.1016/j.giec.2019.12.006.
Rouphael C, Padival R, Sanaka MR, Thota PN. Endoscopic treatments of GERD. Curr Treat Options Gastroenterol. 2018 Mar;16(1):58–71. https://doi.org/10.1007/s11938-018-0170-6.
Kalapala R, Singla N, Reddy DN. Endoscopic management of gastroesophageal reflux disease: panacea for proton pump inhibitors dependent/refractory patients. Dig Endosc. 2022;34(4):687–99. https://doi.org/10.1111/den.14169.
Rodríguez de Santiago E, Albéniz E, Estremera-Arevalo F, Teruel Sanchez-Vegazo C, Lorenzo-Zúñiga V. Endoscopic anti-reflux therapy for gastroesophageal reflux disease. World J Gastroenterol. 2021;27(39):6601–14. https://doi.org/10.3748/wjg.v27.i39.6601.
Arts J, Bisschops R, Blondeau K, Farré R, Vos R, Holvoet L, Caenepeel P, Lerut A, Tack J. A double-blind sham-controlled study of the effect of radiofrequency energy on symptoms and distensibility of the gastro-esophageal junction in GERD. Am J Gastroenterol. 2012 Feb;107(2):222–30. https://doi.org/10.1038/ajg.2011.395.
•• Lee DP, Chang KJ. Endoscopic management of GERD. Dig Dis Sci. 2022 May;67(5):1455–68. https://doi.org/10.1007/s10620-022-07390-2. The authors describe in detail the innovating options for the endoscopic management of GERD and suggest the strategies they recommend and use selectively for their patients.
Duarte Chavez R, Marino D, Kahaleh M, Tyberg A. Endoscopic treatment of reflux: a comprehensive review. J Clin Gastroenterol. 2022;56(10):831–43. https://doi.org/10.1097/MCG.0000000000001757.
He S, Xu F, Xiong X, Wang H, Cao L, Liang N, Wang H, Jing X, Liu T. Stretta procedure versus proton pump inhibitors for the treatment of nonerosive reflux disease: a 6-month follow-up. Medicine (Baltimore). 2020 Jan;99(3):e18610. https://doi.org/10.1097/MD.0000000000018610.
Viswanath Y, Maguire N, Obuobi RB, Dhar A, Punnoose S. Endoscopic day case antireflux radiofrequency (Stretta) therapy improves quality of life and reduce proton pump inhibitor (PPI) dependency in patients with gastro-oesophageal reflux disease: a prospective study from a UK tertiary Centre. Frontline Gastroenterol. 2019 Apr;10(2):113–9. https://doi.org/10.1136/flgastro-2018-101028.
•• Zerbib F, Sacher-Huvelin S, Coron E, Coffin B, Melchior C, Ponchon T, Cholet F, Chabrun E, Vavasseur F, Gorbatchef C, Zalar A, Mion F, Robaszkiewicz M, Le Rhun M, Leroy M, Paul Galmiche J, Bruley des Varannes S. Randomised clinical trial: oesophageal radiofrequency energy delivery versus sham for PPI-refractory heartburn. Aliment Pharmacol Ther 2020;52(4):637-645. https://doi.org/10.1111/apt.15936. This sham-controlled, randomized study did not show any efficacy of Stretta for the treatment of PPI-refractory heartburn, specifically symptom relief or PPI use.
Xie P, Yan J, Ye L, Wang C, Li Y, Chen Y, Li G. Efficacy of different endoscopic treatments in patients with gastroesophageal reflux disease: a systematic review and network meta-analysis. Surg Endosc. 2021;35(4):1500–10. https://doi.org/10.1007/s00464-021-08386-1.
Sui X, Gao X, Zhang L, Zhang B, Zhong C, Chen Y, Wang X, Li D, Wu W, Li L. Clinical efficacy of endoscopic antireflux mucosectomy vs. Stretta radiofrequency in the treatment of gastroesophageal reflux disease: a retrospective, single-center cohort study. Ann Transl Med 2022;10(12):660. https://doi.org/10.21037/atm-22-2071.
Ma L, Li T, Liu G, Wang J, Yin Z, Kang J. Stretta radiofrequency treatment vs Toupet fundoplication for gastroesophageal reflux disease: a comparative study. BMC Gastroenterol. 2020;20(1):162. https://doi.org/10.1186/s12876-020-01310-2.
Rausa E, Ferrari D, Kelly ME, Aiolfi A, Vitellaro M, Rottoli M, Bonitta G, Bona D. Efficacy of laparoscopic Toupet fundoplication compared to endoscopic and surgical procedures for GERD treatment: a randomized trials network meta-analysis. Langenbeck's Arch Surg. 2023;408(1):52. https://doi.org/10.1007/s00423-023-02774-y.
Jung HY. In which situation is endoscopic radiofrequency anti-reflux therapy (Stretta) effective for controlling Gastroesophageal reflux symptoms? Clin Endosc. 2021;54(4):451–2. https://doi.org/10.5946/ce.2021.190.
Nevins EJ, Dixon JE, Viswanath YKS. The outcome of endoscopic radiofrequency anti-reflux therapy (STRETTA) for Gastroesophageal reflux disease in patients with previous gastric surgery: a prospective cohort study. Clin Endosc. 2021;54(4):542–7. https://doi.org/10.5946/ce.2020.243.
Guzman-Pruneda FA, Brethauer SA. Gastroesophageal reflux after sleeve Gastrectomy. J Gastrointest Surg. 2021;25(2):542–50. https://doi.org/10.1007/s11605-020-04786-1.
Khidir N, Angrisani L, Al-Qahtani J, Abayazeed S, Bashah M. Initial experience of endoscopic radiofrequency waves delivery to the lower Esophageal sphincter (Stretta procedure) on symptomatic Gastroesophageal reflux disease post-sleeve Gastrectomy. Obes Surg. 2018;28(10):3125–30. https://doi.org/10.1007/s11695-018-3333-6.
Fanous M, Jaehne A, Simbob J. The benefits of nonablative radiofrequency treatment of the lower Esophageal sphincter after Transoral Incisionless fundoplication. Am Surg 2020 ;86(11):1525-1527. https://doi.org/10.1177/0003134820933586.
Fanous M, Jaehne A, Williams S. The role of Transoral Incisionless fundoplication after the Stretta procedure. Am Surg. 2021 Dec;87(12):1986–8. https://doi.org/10.1177/0003134820933602.
Kolbeinsson HM, Lawson C, Banks-Venegoni A, Girgis R, Scheeres DE. Treatment of Gastroesophageal reflux disease after lung transplant using radiofrequency ablation to the lower Esophageal sphincter (Stretta procedure). Am Surg. 2022 Jul;88(7):1663–8. https://doi.org/10.1177/0003134821998678.
Rouphael C, Padival R, Sanaka MR, Thota PN. Endoscopic treatments of GERD. Curr Treat Options Gastroenterol. 2018;16(1):58–71. https://doi.org/10.1007/s11938-018-0170-6.
Bortolotti M. Is patient satisfaction sufficient to validate endoscopic anti-reflux treatments? World J Gastroenterol. 2022;28(28):3743–6. https://doi.org/10.3748/wjg.v28.i28.3743.
Funding
None.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of Interests
The authors declare no competing interests.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Triadafilopoulos, G. Endoscopic Non-ablative Radiofrequency Treatment (Stretta) for Gastroesophageal Reflux Disease (GERD). Curr Gastroenterol Rep 26, 93–98 (2024). https://doi.org/10.1007/s11894-024-00917-9
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11894-024-00917-9