Radio Frequency Endoscopic Anti-Reflux (STRETTA) Procedure for the Tratment of Refractory GERD in Elderly Patients

Abstract

Radio Frequency Endoscopic Anti-Reflux (STRETTA) Procedure for the Tratment of Refractory GERD in Elderly Patients Herbert Wolfsen, Lois Hemminger Purpose: Age-related changes in the esophagus include altered motility and sensitivity to acid reflux. Elderly patients with acid reflux symptoms refractory to medical therapy represent a difficult clinical management challenge. Methods: After IRB approval, we reviewed the records of patients O65 years old who have undergone the Stretta procedure. Our Stretta clinical protocol requires documentation of GERD by ambulatory esophageal pH testing. Endoscopy is required to rule out Barrett’s disease, severe esophagitis or large hiatal hernia. All patients undergo esophageal motility testing and laparoscopic surgery consultation to discuss fundoplication. These patients were contacted to update their current symptom status and use of medications. We inquired about procedure complications, medication use and current symptoms. Results: Since January 2001, we have treated 13 patients (7 women) with the Stretta endoscopic anti-reflux device. Follow up information was available on 11/13 patients (85%). The median patient age was 71 years (range 67-75). Median time since Stretta was 21 months (range 841). No patients reported any treatment complications or new symptoms after Stretta. None had subsequently undergone other endoscopic or surgical reflux treatment. All patients were using twice daily PPI C/ bedtime H2RA. At follow up, 4 patients were off medication, 1 patient was using ‘‘prn’’ H2RA or PPI, daily PPI was used in 5 patients and twice daily PPI was still used in 1 patient. Conclusions: In this limited study of elderly patients over age 65 years with medically refractory acid reflux disease, treatment with the Stretta procedure was associated with decreased medication use in most patients (10/11). No treatment complications or new symptoms had developed nearly 2 years, median, after Stretta. In our experience, Stretta has been useful in the management of these difficult patients.