The recently published “Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease” did not properly address the role of radiofrequency endoscopic therapy for GERD (Stretta procedure) grouping it with other techniques abandoned for insufficient efficacy or concerns about safety.
Stretta has been widely used and studied over the past 13 years in several randomized controlled trials and long-term durability studies, as recently reviewed in a meta-analysis of 18 studies covering 1441 patients (Perry KA et al Surg Lap Endoscopy Perc Tech 2012; 22:283-288). In all these studies, Stretta significantly reduced esophageal acid exposure and normalized it in a proportion of patients. More importantly, Stretta was shown to be a safe, durable and effective procedure when considering the main endpoint of GERD treatment (i.e. symptom control).
Approximately one third of reflux patients today have inadequate response to PPI therapy and are not willing to undergo fundoplication. Stretta provides an invaluable adjunct in the treatment of GERD that spans the “gap” between PPI responders and surgical candidates.
As the precise physiologic dysfunction exhibited by GERD sufferers is not completely understood, it stands to reason that multiple therapeutic modalities – used alone or even in combination -may contribute to symptom control. The abundance of clinical data on Stretta confirms the following: 1) tissue destruction and creation of fibrosis does not occur; 2) symptom control in PPI dependent patients occurs consistently; 3) a variety of functional improvements occur in the distal esophagus including improved acid sensitivity and tissue compliance; and 4) the procedure is exceedingly safe and reproducible.
There is unquestionably an unmet need for the many sufferers of GERD, particularly the refractory ones, where Stretta has been shown to offer significant improvements by both objective and subjective criteria. Stretta is safe, effective, durable and repeatable if necessary. Further, it does not preclude any other alternative (repeat Stretta, PPI addition or fundoplication) and is the least expensive alternative to medical therapy.