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Three year’s experience with the Stretta procedure: did it really make a difference?

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Abstract

Background

Endoscopic treatment is merging as a new option for GERD treatment. Many modalities have been used with modest short-term success, but no long-term follow-ups have been published. We present our 3-yr experience at Vanderbilt University using endoscopic radiofrequency energy (Stretta procedure) for GERD treatment.

Methods

Patients with follow-up >6 months were prospectively studied under IRB protocol. All were mailed SF-12 health status questionnaire and GERD specific quality-of-life (QOLRAD) questionnaires, queries about satisfaction with Stretta, and medication use. All were invited for 24-hour pH study.

Results

Eighty-six Stretta procedures were performed between 8/2000 and 7/2003 on 85 patients; all were outpatients, 89% under conscious sedation. Seventy-seven patients qualified for the study; 61 completed the survey, 24 returned for pH study. Follow-up was 26.2 +/- 7.5 months (6-36). All were on daily PPIs, with proven GERD by pH study or endoscopy. Mean preoperative acid exposure time was 7.8+/-2.6%, mean DeMeester score was 40.2+/-17.6. Postoperative mean acid exposure time was 5.1+/-3.3 (p=0.00l), DeMeester score was 29.5+/-20.5 (p=0.041). Normal postoperative acid exposure time (pH<4 in <4.2%) was achieved in 42% of patients tested. Patients were then divided according to medication use at the end of f/u in 2 groups: Responders (off or >50% decrease in PPI dose), and nonresponders (on >50% of original PPI dose, or had fundoplication). Response rate was 60% (39 patients), 8 nonresponders underwent fundoplication (12%). Satisfaction rate was 73%. Statistically significant difference was found between the 2 groups in all measurements; SF-12 physical and mental score for responders were 45.5+/-10.2, and 52.6+/-7.8; and for nonresponders were 37.8+/-11.2 and 40.9+/-11.3 (p=0.012, p=0.000l), respectively. Statistically significant difference was also found between responders and nonresponders in postoperative acid exposure (4.5+/-3.34 vs 7.2+/-2.3, p=0.034), and DeMeester score (26.3+/-20.4 vs 39.7+/-20.2, p=0.05). Paired T test was used to compare pre- and postoperative acid exposure in each group; statistically significant difference was found only among responders: total reflux time was 7.50+/-2.3 preop and 4.5+/-3.34 postop (p=0.000l), whereas for nonresponders it was 8.6+/-3.7 and 7.2+/-2.3 (p=0.8), DeMeester scores pre- and postop among responders were 40.0+/-19.7 and 26.3+/-20.4, respectively (p=0.016), whereas for nonresponders it was 40.5+/-14.3 and 39.7+/-20.2 (p=0.79).

Conclusions

Stretta is a safe modestly effective, totally endoscopic treatment for GERD. Symptomatic improvement when achieved is often associated with correlating improvement in distal acid exposure. This exposure normalizes in nearly half the treated patients.

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References

  1. MT Caldwell P Lawlor PJ Byrne TN Walsh TP Hennessy (1995) ArticleTitleAmbulatory oesophageal bile reflux monitoring in Barrett’s oesophagus Br J Surg 82 657–660 Occurrence Handle1:STN:280:ByqA3sfmvVY%3D Occurrence Handle7613943

    CAS  PubMed  Google Scholar 

  2. DO Castell M Vela (2001) ArticleTitleCombined multichannel intraluminal impedance and pH-metry: an evolving technique to measure type and proximal extent of gastroesophageal reflux Am J Med 111 . IssueIDSuppl 8A 157S–159S

    Google Scholar 

  3. G Champion JE Richter MF Vaezi S Singh R Alexander (1994) ArticleTitleDuodenogastroesophageal reflux: relationship to pH and importance in Barrett’s esophagus Gastroenterology 107 747–754 Occurrence Handle1:STN:280:ByuA2Mjjslc%3D Occurrence Handle8076761

    CAS  PubMed  Google Scholar 

  4. DA Corley P Katz JM Wo A Stefan M Patti R Rothstein S Edmundowicz et al. (2003) ArticleTitleImprovement of gastroesophageal reflux symptoms after radiofrequency energy: a randomized, sham-controlled trial Gastroenterology 125 668–676 Occurrence Handle10.1016/S0016-5085(03)01052-7 Occurrence Handle12949712

    Article  PubMed  Google Scholar 

  5. DA Corley P Katz J Wo A Stefan M Patti R Rothstein S Edmundowicz M Kline R Mason MM Wolf (2003) ArticleTitleImprovement of gastroesophageal reflux symptoms after radiofrequency energy: a randomized, sham-controlled trial Gastroenterology 125 668–676 Occurrence Handle10.1016/S0016-5085(03)01052-7 Occurrence Handle12949712

    Article  PubMed  Google Scholar 

  6. MS TA Dassinger HL Houston MD Holzman KW Sharp WO Richards (2004) ArticleTitleLaparoscopic fundoplicaiton: 5-year follow-up Am Surg 70 691–695 Occurrence Handle1:STN:280:DC%2BD2cvitlersQ%3D%3D Occurrence Handle15328802

    CAS  PubMed  Google Scholar 

  7. SR DeMeester TR DeMeester (2000) ArticleTitleColumnar mucosa and intestinal metaplasia of the esophagus: fifty years of controversy Ann Surg 231 303–321 Occurrence Handle1:STN:280:DC%2BD3c7nslWjtw%3D%3D Occurrence Handle10714623

    CAS  PubMed  Google Scholar 

  8. TR DeMeester L Bonavina M Albertucci (1986) ArticleTitleNissen fundoplication for gastroesophageal reflux disease: evaluation of primary repair in 100 consecutive patients Ann Surg 204 9–20 Occurrence Handle1:STN:280:BimB28fgslw%3D Occurrence Handle3729589

    CAS  PubMed  Google Scholar 

  9. JK Dibaise RE Brand EM Quigley (2002) ArticleTitleEndoluminal delivery of radiofrequency energy to the gastroesophageal junction in uncomplicated GERD: efficacy and potential mechanism of action Am J Gastroenterol 97 833–842 Occurrence Handle10.1016/S0002-9270(02)03953-9 Occurrence Handle12003416

    Article  PubMed  Google Scholar 

  10. M Fein AP Ireland MP Ritter JH Peters JA Hagen CG Bremner TR DeMeester (1997) ArticleTitleDuodenogastric reflux potentiates the injurious effects of gastroesophageal reflux J Gastrointest Surg 1 27–33 Occurrence Handle9834327

    PubMed  Google Scholar 

  11. JP Galmiche S Bruley des Varannes (2003) ArticleTitleEndoluminal therapies for gastro-oesophageal reflux disease Lancet 361 1119–1121 Occurrence Handle12672327

    PubMed  Google Scholar 

  12. RA Harris M Kuppermann JE Richter (1997) ArticleTitlePrevention of recurrences of erosive reflux esophagitis: a cost-effectiveness analysis of maintenance proton pump inhibition Am J Med 102 78–88 Occurrence Handle1:STN:280:ByiA2M3psVI%3D Occurrence Handle9209204

    CAS  PubMed  Google Scholar 

  13. RA Hinder CJ Filipi G Wetscher P Neary TR DeMeester G Perdikis (1994) ArticleTitleLaparoscopic Nissen fundoplication is an effective treatment for gastroesophageal reflux disease Ann Surg 220 472–481 Occurrence Handle1:STN:280:ByqD3s7jsVI%3D Occurrence Handle7944659

    CAS  PubMed  Google Scholar 

  14. WJ Hogan (2001) ArticleTitleEndoscopic treatment modalities for GERD: technologic score or scare? Gastrointest Endosc 53 541–545 Occurrence Handle1:STN:280:DC%2BD3M7oslSgtQ%3D%3D Occurrence Handle11275912

    CAS  PubMed  Google Scholar 

  15. H Houston L Khaitan M Holzman WO Richards (2003) ArticleTitleFirst-year experience of patients undergoing the Stretta procedure Surg Endosc 17 401–404 Occurrence Handle10.1007/s00464-002-8923-6 Occurrence Handle1:STN:280:DC%2BD3s7gs1ehsQ%3D%3D Occurrence Handle12436238

    Article  CAS  PubMed  Google Scholar 

  16. PJ Howard RC Heading (1992) ArticleTitleEpidemiology of gastro-esophageal reflux disease World J Surg 16 288–293 Occurrence Handle1:STN:280:By2B387msF0%3D Occurrence Handle1561813

    CAS  PubMed  Google Scholar 

  17. JG Hunter TL Trus GD Branum JP Waring WC Wood (1996) ArticleTitleA physiologic approach to laparoscopic fundoplication for gastroesophageal reflux disease Ann Surg 223 673–685 discussion 685-687 Occurrence Handle1:STN:280:BymB2crhtlY%3D Occurrence Handle8645041

    CAS  PubMed  Google Scholar 

  18. DA Johnson SB Benjamin NB Vakil JL Goldstein M Lamet J Whipple D Damico et al. (2001) ArticleTitleEsomeprazole once daily for 6 months is effective therapy for maintaining healed erosive esophagitis and for controlling gastroesophageal reflux disease symptoms: a randomized, double-blind, placebo-controlled study of efficacy and safety Am J Gastroenterol 96 27–34 Occurrence Handle1:CAS:528:DC%2BD3MXhtFKjsro%3D Occurrence Handle11197282

    CAS  PubMed  Google Scholar 

  19. PJ Kahrilas (1996) ArticleTitleGastroesophageal reflux disease JAMA 276 983–988 Occurrence Handle1:STN:280:BymA1Mbhs1c%3D Occurrence Handle8805734

    CAS  PubMed  Google Scholar 

  20. PJ Kahrilas (2001) ArticleTitleSurgical therapy for reflux disease JAMA 285 2376–2378 Occurrence Handle1:STN:280:DC%2BD3M3ntleiug%3D%3D Occurrence Handle11343486

    CAS  PubMed  Google Scholar 

  21. T Lafullarde DI Watson GG Jamieson JC Myers PA Game PG Devitt (2001) ArticleTitleLaparoscopic Nissen fundoplication: five-year results and beyond Arch Surg 136 180–184 Occurrence Handle1:STN:280:DC%2BD3M7ptlensg%3D%3D Occurrence Handle11177138

    CAS  PubMed  Google Scholar 

  22. CA McHorney JE Ware SuffixJr AE Raczek (1993) ArticleTitleThe MOS 36-item short-form health survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs Med Care 31 247–263 Occurrence Handle1:STN:280:ByyC1MnisVI%3D

    CAS  Google Scholar 

  23. JH Peters TR DeMeester P Crookes S Oberg M Vos Shoop Particlede JA Hagen CG Bremner (1998) ArticleTitleThe treatment of gastroesophageal reflux disease with laparoscopic Nissen fundoplication: prospective evaluation of 100 patients with “typical” symptoms Ann Surg 228 40–50 Occurrence Handle1:STN:280:DyaK1czjsVWnsg%3D%3D Occurrence Handle9671065

    CAS  PubMed  Google Scholar 

  24. WO Richards S Scholz L Khaitan KW Sharp MD Holzman (2001) ArticleTitleInitial experience with the Stretta procedure for the treatment of gastroesophageal reflux disease J Laparoendosc Adv Surg Tech A 11 267–273 Occurrence Handle1:STN:280:DC%2BD3Mrmt1Orsg%3D%3D Occurrence Handle11642661

    CAS  PubMed  Google Scholar 

  25. WO Richards HL Houston A Torquati L Khartan MD Holzman KW Sharp (2003) ArticleTitleParadigm shift in the management of gastroesophageal reflux disease Ann Surg 237 638–647 discussion 648-649 Occurrence Handle10.1097/00000658-200305000-00006 Occurrence Handle12724630

    Article  PubMed  Google Scholar 

  26. WS Richardson TL Trus JG Hunter (1996) ArticleTitleLaparoscopic antireflux surgery Surg Clin North Am 76 437–450 Occurrence Handle1:STN:280:BymB283isFE%3D Occurrence Handle8669004

    CAS  PubMed  Google Scholar 

  27. CP Swain TN Mills (1986) ArticleTitleAn endoscopic sewing machine Gastrointest Endosc 32 36–38 Occurrence Handle1:STN:280:BimC3sjivF0%3D Occurrence Handle3512359

    CAS  PubMed  Google Scholar 

  28. MT Thiny NJ Shaheen (2002) ArticleTitleIs Stretta ready for primetime? Gastroenterology 123 643–644; discussion 644-645 Occurrence Handle12145818

    PubMed  Google Scholar 

  29. A Torquati H Houston J Kaiser M Holzman WO Richards (2004) ArticleTitleLong-term results of the Stretta procedure for the treatment of gastroesophageal reflux disease (GERD) Surg Endosc 18 1475–1479 Occurrence Handle1:STN:280:DC%2BD2M7lvVOhsQ%3D%3D Occurrence Handle15791372

    CAS  PubMed  Google Scholar 

  30. G Triadafilopoulos JK DiBaise TT Nostrant NH Stollmnan PK Anderson MM Wolfe RI Rothstein et al. (2002) ArticleTitleThe 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 Occurrence Handle10.1067/mge.2002.121227 Occurrence Handle11818914

    Article  PubMed  Google Scholar 

  31. MF Vaezi JE Richter (1996) ArticleTitleRole of acid and duodenogastroesophageal reflux in gastroesophageal reflux disease Gastroenterology 111 1192–1199 Occurrence Handle1:STN:280:ByiD2MvjtlE%3D Occurrence Handle8898632

    CAS  PubMed  Google Scholar 

  32. S Vigneri R Termini G Leandro S Badalamenti M Pantalena V Savarino F Di Mario et al. (1995) ArticleTitleA comparison of five maintenance therapies for reflux esophagitis N Engl J Med 333 1106–1110 Occurrence Handle1:CAS:528:DyaK28XjvVWn Occurrence Handle7565948

    CAS  PubMed  Google Scholar 

  33. JE Ware M Kosinski (1993) SF-36 health survey: manual and interpretation guide The Health Institute, New England Medical Center Boston

    Google Scholar 

  34. JM Weerts B Dallemagne E Hamoir M Demarche S Markiewicz C Jehaes R Lombard et al. (1993) ArticleTitleLaparoscopic Nissen fundoplication: detailed analysis of 132 patients Surg Laparosc Endosc 3 359–364 Occurrence Handle1:STN:280:ByuD1cvkvVE%3D Occurrence Handle8261262

    CAS  PubMed  Google Scholar 

  35. IK Wiklund O Junghard E Grace NJ Talley M Kamm S Veldhuyzen Zanten Particlevan P Pare et al. (1998) ArticleTitleQuality of Life in Reflux and Dyspepsia patients: psychometric documentation of a new disease-specific questionnaire (QOLRAD) Eur J Surg 583 IssueIDSuppl 41–49

    Google Scholar 

  36. HC Wolfsen WO Richards (2002) ArticleTitleThe Stretta procedure for the treatment of GERD: a registry of 558 patients J Laparoendosc Adv Surg Tech A 12 395–402 Occurrence Handle12590718

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Vanderbilt University Medical Center, D-5219 MCN, Nashville, TN 37232, USA

    R. E. Lutfi, A. Torquati, J. Kaiser, M. Holzman & W. O. Richards

Authors
  1. R. E. Lutfi
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  2. A. Torquati
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  3. J. Kaiser
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  4. M. Holzman
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  5. W. O. Richards
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Correspondence to W. O. Richards.

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Lutfi, R.E., Torquati, A., Kaiser, J. et al. Three year’s experience with the Stretta procedure: did it really make a difference?. Surg Endosc 19, 289–295 (2005). https://doi.org/10.1007/s00464-004-8938-2

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