Skip to main content
SpringerLink
Log in

Radiofrequency energy delivery to the lower esophageal sphincter (Stretta procedure) in patients with recurrent reflux after antireflux surgery

Can surgery be avoided?

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Recurrent reflux following antireflux surgery (ARS) can be difficult to manage, especially in patients who also fail medical management. In these patients, redo ARS remains the only treatment option. Endoscopic radiofrequency energy delivery to the lower esophageal sphincter (the Stretta procedure; Stretta, Curon, Sunnyvale, CA) has been shown to significantly decreased symptom scores and improve quality of life in patients with gastroesophageal reflux disease (GERD). The aim of this study was to evaluate the use of the Stretta procedure in treating patients with recurrent reflux after fundoplication.

Methods

Between March 2002 and December 2003, eight patients with recurrent reflux following ARS underwent the Stretta procedure. All patients were asked to complete an institutional symptom survey pre-Stretta and at 1, 6, and 12 months after the procedure. Patients rated 7 reflux-related symptoms (heartburn, dysphagia, regurgitation, cough, voice changes/hoarseness, asthma, chest pain) on a 0 (none) to 3 (severe) scale. Data were analyzed using a Wilcoxon matched pairs signed rank test where appropriate.

Results

Complete data were obtained for seven of the eight patients, with a median follow-up of 253 days (range, 67–378 days). One patient was lost to follow-up and not included in our analysis. Symptom scores decreased significantly, with six patients noting both improved typical and atypical symptoms. Overall, six patients (85%) were satisfied with their results.

Conclusions

Based on this small series, the Stretta procedure significantly reduces subjective symptoms of GERD. The Stretta procedure may serve an important role as an additional management strategy to help manage recurrent GERD after ARS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1.

Similar content being viewed by others

References

  1. Corley D, Katz P, Wo J, Stefan A, Rothstein P, Edmundowicz R, Kline M, Mason R, Wolfe M (2003) Improvement of gastroesophageal reflux symptoms after radiofrequency energy: a randomized, sham controlled trial. Gastroenterology 125:668–676

    Article  PubMed  Google Scholar 

  2. Corley DA, Katz P, Wo JM, AS, Rothstein R, Edmundowicz S, Kline M, Mason R, Wolfe MM (2003) Improvement of gastroesophageal reflux symptoms after radiofrequency energy: a randomized, sham-controlled trial. Gastroenterology 125: 970–973

  3. Curon (2002) The Stretta Procedure. Endoluminal delivery of temperature-controlled radiofrequency energy for the treatment of gastroesophageal reflux disease. Procedure summary, patient selection, clinical data Version August 15, 2002

  4. Finlayson SRG, Laycock WS, Birkmeyer JD (2003) National trends in utilization and outcomes of antireflux surgery. Surg Endosc 17:864–867

    Article  PubMed  CAS  Google Scholar 

  5. Flum DR, Koepsell T, Heagerty P, Pelligrini CA (2002) The nationwide frequency of major adverse outcomes in antireflux surgery and the role of surgeon experience, 1992–1997. J Am Coll Surg 195:611–618

    Article  PubMed  Google Scholar 

  6. Hinder RA (2000) Surgical therapy for GERD. Selection of procedures, short- and long-term results. J Clin Gastroenterol 30(Suppl):S48–S50

    PubMed  CAS  Google Scholar 

  7. Horgan S, Pohl D, Bogetti D, Eubanks T, Pelligrini C (1999) Failed antireflux surgery. What have we learned from reoperations? Arch Surg 134:805–888

    Article  Google Scholar 

  8. Hunter JG, Smith CD, Branum GD, Waring JP, Trus TL, Cornwell M, Galloway KD (1999) Laparoscopic fundoplication failures. Patterns of failure and response to fundoplication revision. Ann Surg 230:595–604

    Article  PubMed  CAS  Google Scholar 

  9. Jamieson GG (1993) The results of anti-reflux surgery and re-operative anti-reflux surgery. Gullet 3:41–45

    Google Scholar 

  10. Soper NJ, Dunnegan D (1999) Anatomic fundoplication failure after laparoscopic anti-reflux surgery. Ann Surg 229:669–677

    Article  PubMed  CAS  Google Scholar 

  11. Spechler S, Lee E, Ahnen D, Goyal R, Hirano I, Ramirez F, Raufman J-P, Sampliner R, Schnell T, Sontag S, Vlahcevic Z, Young R, Williford W (2001) Long-term outcome of medical and surgical therapies for gastroesophageal reflux disease: Follow-up of a randomized controlled trial. JAMA 285:2331–2338

    Article  PubMed  CAS  Google Scholar 

  12. Stein HJ, Feussner H, Siewer JR (1996) Failure of antireflux surgery: causes and management strategies. Am J Surg 171:36–39

    Article  PubMed  CAS  Google Scholar 

  13. Tam W, Dent J (2002) Esophageal motor disorders: future developments: best practice research. Clin Gastroenterol 16:811–833

    Google Scholar 

  14. Tam W, Shoeman M, Zang Q, Rigda R, Dent J, Utley D, Holloway R (2003) Delivery of radiofrequency energy to the lower esophageal sphincter inhibits transient LES relaxations in patients with gastroesophageal reflux disease (GERD). Gut 52:479–485

    Article  PubMed  CAS  Google Scholar 

  15. Triadafilopoulos G, DiBaise JK, Nostrant TT, Anderson PK, Wolfe MM, Rothstein RI, Wo JM, Corley DA, Patti MG, Antignano LV, Goff JS, Edmundowicz SA, Castell DO, Rabine JC, Kim M, Utley DS (2002) The Stretta procedure for the treatment of GERD: 6 and 12 month follow-up of the U.S. open label trial. Gastrointest Endosc 55:149–156

    Article  PubMed  Google Scholar 

  16. Triadafilopoulos G, DiBaise JK, Nostrant TT, Stollman NH, Anderson PK, Edmundowicz SA, Castell DO, Kim MS, Rabine JC, Utley DS (2001) Radiofrequency energy delivery to the gastroesophageal junction for the treatment of GERD. Gastrointest Endosc 53:541–545

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Emory Endosurgery Unit & Gastroesophageal Treatment Center, Emory University Hospital, 1364 Clifton Road, N.E., Surgery, Suite H-124, Atlanta, Georgia, 30322

    D. A. McClusky III, L. Khaitan & V. A. Swafford

  2. Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA

    C. D. Smith

Authors
  1. D. A. McClusky III
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L. Khaitan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. V. A. Swafford
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. D. Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. D. Smith.

Rights and permissions

Reprints and permissions

About this article

Cite this article

McClusky, D.A., Khaitan, L., Swafford, V.A. et al. Radiofrequency energy delivery to the lower esophageal sphincter (Stretta procedure) in patients with recurrent reflux after antireflux surgery. Surg Endosc 21, 1207–1211 (2007). https://doi.org/10.1007/s00464-007-9195-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-007-9195-y

Keywords

Search

Navigation