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a hepatologie

Gastroenterology and Hepatology

Gastroent Hepatol 2022; 76(3): 228–235. doi: 10.48095/ccgh2022228.

Endoscopic therapy of gastroesophageal reflux disease using radiofrequency energy (Stretta procedure) – treatment of the first patients in the Czech Republic

Kateřina Košťálová  1, Štěpán Suchánek  1, Lucie Zdrhová2, Jana Koželuhová  2, Miroslav Zavoral  1, Petr Urbánek3, Karel Balihar  2

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Gastroesophageal reflux disease (GERD) is the most common disease of the gastrointestinal tract, affecting approximately a quarter of the European population with an increasing incidence. Some patients with GERD do not get full relief with conservative approach with proton pump inhibitors (PPI), while surgical solution is burdened with a significant percentage of complications and its effectiveness decreases over time. Endoscopic therapy of GERD currently includes five different methods, none of which have, to the knowledge of the authors, been more widely available and performed in the Czech Republic. The methods of electrical oesophageal stimulation, endoscopic fundoplication and Stretta have the potential to be used in practice. The latter method consists in the application of a low-frequency radiofrequency energy to the oesophagogastric junction (EGJ). According to the data published so far, it is probably a less effective alternative to laparoscopic fundoplication for patients with hiatal hernia ≤ 2 cm and failed conservative treatment, but its favourable safety profile, absence of EGJ anatomy alteration, repeatability and long-time effect in most patients are its undeniable advantages. On the other hand, the need to select suitable patients for the procedure and higher costs are among its disadvantages. Despite its limitations, Stretta offers an alternative option in the future for selected patients who would like to avoid the risks associated with long-term PPIs and are concerned about the risks of laparoscopic fundoplication.


gastroesophageal reflux disease, endoscopic therapy, radiofrequency energy, Stretta

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1. Lukás K, Bures J, Drahonovský V et al. Gas­troesophageal reflux disease. Standards of the Czech Society of Gastroenterology – actualization 2009. Vnitr Lek 2009; 55(10): 967–975.
2. El-Serag HB, Sweet S, Winchester CC et al. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 2014; 63(6): 871–880. doi: 10.1136/gut jnl-2012-304269.
3. Hershcovici T, Mashimo H, Fass R. The lower esophageal sphincter. Neurogastroenterol Motil 2011; 23(9): 819–830. doi: 10.1111/ j.1365-2982.2011.01738.x.
4. Lagergren J, Bergström R, Lindgren A et al. Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med 1999; 340(11): 825–831. doi: 10.1056/NEJM199903183401101.
5. El-Serag H, Becher A, Jones R. Systematic review: persistent reflux symptoms on proton pump inhibitor therapy in primary care and community studies. Aliment Pharmacol Ther 2010; 32(6): 720–737. doi: 10.1111/j.1365-20 36.2010.04406.x.
6. Perry IE, Sonu I, Scarpignato C et al. Potential proton pump inhibitor-related adverse effects. Ann N Y Acad Sci 2020; 1481(1): 43–58. doi: 10.1111/nyas.14428.
7. Lind T. Changing surgical principles for gastro-oesophageal reflux disease – is laparoscopic fundoplication justified in the light of surgical complications? Eur J Surg Suppl 2000; (585): 31–33. doi: 10.1080/110241500750056517.
8. Broeders JA, Rijnhart-de Jong HG, Draaisma WA et al. Ten-year outcome of laparoscopic and conventional nissen fundoplication: randomized clinical trial. Ann Surg 2009; 250(5): 698–706. doi: 10.1097/SLA.0b013e3181bcdaa7.
9. Spechler SJ, Lee E, Ahnen D et al. Long-term outcome of medical and surgical therapies for gastroesophageal reflux disease: follow-up of a randomized controlled trial. JAMA 2001; 285(18): 2331–2338. doi: 10.1001/jama.285.18. 2331.
10. Garg SK, Gurusamy KS. Laparoscopic fundoplication surgery versus medical management for gastro-oesophageal reflux disease (GORD) in adults. Cochrane Database Syst Rev 2015; 2015(11): CD003243. doi: 10.1002/14651858.CD003243.pub3.
11. Bonavina L, Attwood S. Laparoscopic alternatives to fundoplication for gastroesophageal reflux: the role of magnetic augmentation and electrical stimulation of the lower esophageal sphincter. Dis Esophagus 2016; 29(8): 996–1001. doi: 10.1111/dote.12425.
12. Madalosso CAS, Gurski RR, Callegari-Jacques SM et al. The impact of gastric bypass on gas­troesophageal reflux disease in morbidly obese patients. Ann Surg 2016; 263(1): 110–116. doi: 10.1097/SLA.0000000000001139.
13. Kushner BS, Awad MM, Mikami DJ et al. Endoscopic treatments for GERD. Ann N Y Acad Sci 2020; 1482(1): 121–129. doi: 10.1111/nyas.14511.
14. Banerjee R, Pratap N, Kalpala R et al. Effect of electrical stimulation of the lower esophageal sphincter using endoscopically implanted temporary stimulation leads in patients with reflux disease. Surg Endosc 2014; 28(3): 1003–1009. doi: 10.1007/s00464-013-3271-2.
15. Inoue H, Tanabe M, de Santiago ER et al. Anti-reflux mucosal ablation (ARMA) as a new treatment for gastroesophageal reflux refractory to proton pump inhibitors: a pilot study. Endosc Int Open 2020; 8(2): E133–138. doi: 10.1055/a-1031-9436.
16. Utley DS, Kim M, Vierra MA et al. Augmentation of lower esophageal sphincter pressure and gastric yield pressure after radiofrequency energy delivery to the gastroesophageal junction: a porcine model. Gastrointest Endosc 2000; 52(1): 81–86. doi: 10.1067/mge.2000.105981.
17. Ďuriček M, Schnierer M. Význam regulácie tranzientných relaxácii dolného pažerákového zvierača v patogenéze pažerákovej refluxovej choroby. Gastroent Hepatol 2016; 70(4): 305–309. doi: 10.14735/amgh2016csgh. info09.
18. Korniienko D, Oparin A. Mechanizmy vzniku motorických a evakuačních poruch při gastroesofageálním refluxním chorobě se souběžnou obezitou. Gastroent Hepatol 2017; 71(2): 145–149. doi: 10.14735/amgh2017csgh.info01.
19. Kim MS, Holloway RH, Dent J et al. Radiofrequency energy delivery to the gastric cardia inhibits triggering of transient lower esophageal sphincter relaxation and gastroesophageal reflux in dogs. Gastrointest Endosc 2003; 57(1): 17–22. doi: 10.1067/mge.2003.23.
20. Arts J, Bisschops R, Blondeau K et al. A double-blind sham-controlled study of the effect of radiofrequency energy on symptoms and distensibility of the gastro-esophageal junction in GERD. Am J Gastroenterol 2012; 107(2): 222–230. doi: 10.1038/ajg.2011.395.
21. Triadafilopoulos G. Stretta: a valuable endoscopic treatment modality for gastroesophageal reflux disease. World J Gastroenterol 2014; 20(24): 7730–7738. doi: 10.3748/wjg.v20.i24.7730.
22. Noar MD, Noar E. Gastroparesis associated with gastroesophageal reflux disease and cor­responding reflux symptoms may be corrected by radiofrequency ablation of the cardia and esophagogastric junction. Surg Endosc 2008; 22(11): 2440–2444. doi: 10.1007/s00464-008-98 73-4.
23. Perry KA, Banerjee A, Melvin WS. Radiofrequency energy delivery to the lower esophageal sphincter reduces esophageal acid exposure and improves GERD symptoms: a systematic review and meta-analysis. Surg Laparosc Endosc Percutan Tech 2012; 22(4): 283–288. doi: 10.1097/SLE.0b013e3182582e92.
24. Lipka S, Kumar A, Richter JE. No evidence for efficacy of radiofrequency ablation for treatment of gastroesophageal reflux disease: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2015; 13(6): 1058–1067.e1. doi: 10.1016/j.cgh.2014.10.013.
25. Fass R, Cahn F, Scotti DJ et al. Systematic review and meta-analysis of controlled and prospective cohort efficacy studies of endoscopic radiofrequency for treatment of gastroesophageal reflux disease. Surg Endosc 2017; 31(12): 4865–4882. doi: 10.1007/s00464-017-54 31-2.
26. Xie P, Yan J, Ye L et al. Efficacy of different endoscopic treatments in patients with gastroesophageal reflux disease: a systematic review and network meta-analysis. Surg Endosc 2021; 35(4): 1500–1510. doi: 10.1007/s00464-021-083 86-1.
27. Noar M, Squires P, Noar E et al. Long-term maintenance effect of radiofrequency energy delivery for refractory GERD: a decade later. Surg Endosc 2014; 28(8): 2323–2333. doi: 10.1007/s00 464-014-3461-6.
28. Liang W-T, Yan C, Wang Z-G et al. Early and midterm outcome after laparoscopic fundoplication and a minimally invasive endoscopic procedure in patients with gastroesophageal reflux disease: a prospective observational study. J Laparoendosc Adv Surg Tech A 2015; 25(8): 657–661. doi: 10.1089/lap.2015.0188.
29. Yan C, Liang W-T, Wang Z-G et al. Comparison of stretta procedure and toupet fundoplication for gastroesophageal reflux disease-related extra-esophageal symptoms. World J Gastroenterol 2015; 21(45): 12882–12887. doi: 10.3748/wjg.v21.i45.12882.
30. Liang WT, Wu JM, Wang F et al. Stretta radiofrequency for gastroesophageal reflux disease-related respiratory symptoms: a prospective 5-year study. Minerva Chir 2014; 69(5): 293–299.
31. Zhang C, Wu J, Hu Z et al. Dia­gnosis and anti-reflux therapy for GERD with respiratory symptoms: a study using multichannel intraluminal impedance-pH monitoring. PLoS One 2016; 11(8): e0160139. doi: 10.1371/journal.pone.0160139.
32. Smith CD. SAGES clinical spotlight review: endoluminal treatments for gastroesophageal reflux disease (GERD). Surg Endosc 2013; 27(8): 2655–2657. doi: 10.1007/s00464-013-3010-8.
33. Muthusamy VR, Lightdale JR, Acosta RD et al. The role of endoscopy in the management of GERD. Gastrointest Endosc 2015; 81(6): 1305–1310. doi: 10.1016/j.gie.2015.02.021.
34. Noar M, Squires P, Khan S. Radiofrequency energy delivery to the lower esophageal sphincter improves gastroesophageal reflux patient-reported outcomes in failed laparoscopic Nissen fundoplication cohort. Surg Endosc 2017; 31(7): 2854–2862. doi: 10.1007/s00464-016-5296-9.
35. 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 2018; 28(10): 3125–3130. doi: 10.1007/s11695-018-3333-6.
36. Suter M. Gastroesophageal reflux disease, obesity, and roux-en-Y gastric bypass: complex relationship – a narrative review. Obes Surg 2020; 30(8): 3178–3187. doi: 10.1007/s11695 -020-04690-2.
37. Triadafilopoulos G, DiBaise JK, Nostrant TT et al. The stretta procedure for the treatment of GERD: 6 and 12 month follow-up of the U.S. open label trial. Gastrointest Endosc 2002; 55(2): 149–156. doi: 10.1067/mge.2002.121227.
38. Coron E, Sebille V, Cadiot G et al. Clinical trial: radiofrequency energy delivery in proton pump inhibitor-dependent gastro-oesophageal reflux disease patients. Aliment Pharmacol Ther 2008; 28(9): 1147–1158. doi: 10.1111/j.1365-2036.2008.03790.x.

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