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Long-term maintenance effect of radiofrequency energy delivery for refractory GERD: a decade later

Abstract

Background

Patients with gastroesophageal reflux disease (GERD) often seek alternative therapy for inadequate symptom control, with over 40 % not responding to medical treatment. We evaluated the long-term safety, efficacy, and durability of response to radiofrequency treatment of the lower esophageal sphincter (Stretta).

Methods

Using an intent-to-treat analysis, we prospectively assessed 217 patients with medically refractory GERD before and after Stretta. There was no concurrent control group in the study. Primary outcome measure was normalization of GERD-health-related quality of life (GERD-HRQL) in 70 % or greater of patients at 10 years. Secondary outcomes were 50 % reduction or elimination of proton pump inhibitors (PPIs) and 60 % or greater improvement in satisfaction at 10 years. Successful treatment was defined as achievement of secondary outcomes in a minimum of 50 % of patients. Complications and effect on existing comorbidities were evaluated. The results of a 10-year study are reported.

Results

The primary outcome was achieved in 72 % of patients (95 % confidence interval 65–79). For secondary outcomes, a 50 % or greater reduction in PPI use occurred in 64 % of patients, (41 % eliminating PPIs entirely), and a 60 % or greater increase in satisfaction occurred in 54 % of patients. Both secondary endpoints were achieved. The most common side effect was short-term chest pain (50 %). Pre-existing Barrett’s metaplasia regressed in 85 % of biopsied patients. No cases of esophageal cancer occurred.

Conclusions

In this single-group evaluation of 217 patients before and after Stretta, GERD-HRQL scores, satisfaction, and PPI use significantly improved and results were immediate and durable at 10 years.

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Acknowledgments

This work was supported by an unrestricted grant from the Digestive Health Education Foundation (DHEF00036).

Disclosure

M. D. Noar has served as a member of the clinical advisory board and has received honoraria for speaking and training for Mederi Therapeutics Inc., and has no other conflicts of interest or financial ties to disclose. P. J. Squires, E. N. Noar, and M. L. Lee have no conflicts of interest or financial ties to disclose.

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Noar, M., Squires, P., Noar, E. et al. Long-term maintenance effect of radiofrequency energy delivery for refractory GERD: a decade later. Surg Endosc 28, 2323–2333 (2014). https://doi.org/10.1007/s00464-014-3461-6

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Keywords

  • Stretta
  • GERD
  • Medication use
  • GERD-HRQL
  • Reflux
  • Radiofrequency energy
  • Barrett's