What is Stretta Procedure?
Gastroesophageal reflux disease (GERD) is a chronic disorder that worries at least 14 million Americans daily. Typically, the GERD pattern is represented by heartburn, belching, or dysphagia. It can lead to esophagitis, Barrett’s syndrome, and esophageal cancer. Since 75 – 90% of the symptoms recur within a year after discontinuation of treatment, most patients require lifelong treatment. Medication with proton pump inhibitors (PPIs) successfully cures reflux symptoms in 70-80% of patients. The rest of the patients continue to experience severe heartburn and belching despite medical treatment, which leads to a decrease in the quality of life. These patients may require anti-reflux surgery, with efficacy greater than 90%. However, surgery and the need for general anesthesia carry a potential risk of complications.
In recent years, 3 methods of endoscopic treatment of GERD have been developed:
- the method of stitching folds;
- the injection method;
- the radiofrequency method, also known as the Stretta method.
All of them are offered, as a primary method, before applying the operational method in some patients with GERD.
Stretta Method – the basics of radiofrequency energy
The Stretta method consists in the influence of low-power radiofrequency energy with a controlled temperature through an intraluminal catheter on the muscle layer of the esophagus-gastric junction. Constant monitoring of tissue temperature and automatic modulation of RF energy is used to control tissue heating. A temperature sensor is placed in the active electrode to provide temperature control.
The required temperature (85°C) is set in advance. The power is modulated automatically to achieve, but not exceed the specified temperature. Exposure to RF energy results in the formation of circular thermal damage. Reduction of collagen fibers begins at 65°C, leading to a decrease in tissue volume. Over time, the damage heals, fibroblasts accumulate collagen, which leads to an increase in sphincter tone.
The Stretta method is suitable for patients with GERD, confirmed by the presence of pathological acidity of the esophagus during pH monitoring, expressed by belching and esophagitis. It is also prescribed for patients with indications for antireflux surgery if they have contraindications for anesthesia and a high risk of surgical complications.
In patients with unsuccessful fundoplication or other surgery, the method can also be applied, but this solution requires an individual approach. Candidates for the Stretta method are also patients in whom antisecretory treatment does not eliminate the symptoms, either there is intolerance to antisecretory drugs.
In all patients, the peristaltic function of the esophagus and relaxation during swallowing should be maintained. Contraindications to the Stretta procedure include:
- a hernia of 2 cm or more;
- esophagitis 3 – 4 stage (Severy-Miller);
- Barrett’s syndrome.
- The presence of frequent heartburn, belching;
- Adequate esophagus peristalsis;
- Acid reflux confirmed by pH monitoring;
- The presence of a non-erosive reflux process (esophagitis 1-2 stage according to Savary-Miller, or higher degrees after treatment);
- PPI treatment failure.
- Hernia 2 cm or more;
- Significant dysphagia;
- Esophagitis 3-4 Stage (Savary-Miller classification);
- Inadequate the esophagus peristalsis and its incomplete relaxation;
- Barrett’s Syndrome;
- Systemic diseases and vasculitis.
Mechanism of action
With the Stretta method, 2 mechanisms of action were noted: mechanical narrowing of the esophageal-gastric transition and neurogenic modulation of transient relaxation of the NPS. One study demonstrated an increase in NPS pressure and a decrease in PRNPS within 6 months after treatment. These changes should help reduce acid reflux into the esophagus. Patients with positive dynamics of reflux symptoms also have an improvement in 24-hour pH metrics.