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Initial Experience of Endoscopic Radiofrequency Waves Delivery to the Lower Esophageal Sphincter (Stretta Procedure) on Symptomatic Gastroesophageal Reflux Disease Post-Sleeve Gastrectomy

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Abstract

Background

Gastroesophageal reflux disease (GERD) occurs de novo or intensifies after sleeve gastrectomy (LSG). Endoscopic radiofrequency (Stretta) is a minimally invasive, effective tool to treat GERD. However, Stretta safety and efficacy are unknown in patients with GERD after LSG. To evaluate the safety and efficacy of Stretta treatment post-LSG GERD, quality of life, and PPI dose up to 6 months.

Methods

A retrospective review of all patients’ data who underwent Stretta procedure in our center. Demographics, pre-Stretta lower esophageal manometry, 24-h pH monitoring, endoscopic and radiological findings, GERD symptoms using Quality of Life (HR-QoL) questionnaire, and PPI doses at 0, 3, and 6 months were reviewed.

Results

Fifteen patients had an initial BMI of 44.4 ± 9 kg/m2. Pre-Stretta BMI was 29.7 ± 6.3 kg/m2 with an EWL% of 44 ± 21.4%. Pre-Stretta endoscopic reflux esophagitis was found in 26.7%, and barium imaging showed severe reflux in 40%. The mean DeMeester score was 27.9 ± 6.7. Hypotensive LES pressure occurred in 93.3% of patients. Patients’ mean HR-QoL scores were 42.7 ± 8.9 pre-Stretta and 41.8 ± 11 at 6 months (P = 0.8). One case (6.7%) was complicated by hematemesis. At 6 months, 66.7% of patients were not satisfied, though the PPI medications were ceased in 20%. Two patients (13.3%) underwent Roux-en-Y gastric bypass at 8 months post-Stretta to relieve symptoms.

Conclusions

Stretta did not improve GERD symptoms in patients post-LSG at short-term follow-up, and about 6.7% complication rate was reported. Patients were not satisfied despite the decrease in PPI dose.

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Acknowledgements

We would like to acknowledge Mr. Arnel Alviz (system analyst, Hamad Medical Corporation-Qatar) for his contribution in data collection and statistical analysis.

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Authors and Affiliations

  1. Department of Bariatric Surgery, Hamad Medical Corporation, Doha, Qatar

    Nesreen Khidir & Moataz Bashah

  2. General and Endoscopic Surgery Unit, San Giovanni Bosco Hospital, Naples, Italy

    Luigi Angrisani

  3. Department of General Surgery, Hamad Medical Corporation, Doha, Qatar

    Jowhara Al-Qahtani & Sheraz Abayazeed

  4. Weill Cornell Medical College, Doha, Qatar

    Moataz Bashah

Authors
  1. Nesreen Khidir
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  2. Luigi Angrisani
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  3. Jowhara Al-Qahtani
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  4. Sheraz Abayazeed
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  5. Moataz Bashah
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Correspondence to Nesreen Khidir.

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The authors declare that they have no conflict of interest.

Ethical Approval

The current study was conducted after the research protocol was approved by the institutional review board of the Medical Research Centre at Hamad Medical Corporation (17201/17). For this type of study, formal consent is not required.

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Khidir, N., Angrisani, L., Al-Qahtani, J. et al. Initial Experience of Endoscopic Radiofrequency Waves Delivery to the Lower Esophageal Sphincter (Stretta Procedure) on Symptomatic Gastroesophageal Reflux Disease Post-Sleeve Gastrectomy. OBES SURG 28, 3125–3130 (2018). https://doi.org/10.1007/s11695-018-3333-6

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  • DOI: https://doi.org/10.1007/s11695-018-3333-6

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