S0957 Outcome of Stretta in a Tertiary Medical Center: A Safe and Effective Non-Surgical Option for Refractory GERD

Abstract

INTRODUCTION: GERD is a common chronic condition that can affect quality of life. For a subset of patients, GERD is refractory to lifestyle changes and medications, including PPIs and H2 receptor blockers. Surgical therapies include Nissen fundoplication, but for patients who have already attempted this or do not wish to have surgery, the Stretta procedure is a valuable option. The Stretta procedure delivers radiofrequency energy along the GE junction through an endoscopic catheter. This mechanically alters the GEJ and modulates neural pathways to reduce the frequency of lower esophageal sphincter relaxation. Successful procedures result in symptom resolution, mucosal healing, and/or increased health-related quality of life (HRQoL). METHODS: Retrospective chart review of all patients who underwent the Stretta procedure for GERD from 2005 to 2019 at our center was conducted. Demographics, clinically noted GERD symptoms, including dysphagia heartburn, reflux, and breakthrough symptoms, and PPI usage at baseline and post-procedure were reviewed. RESULTS: Fifty-nine procedures were performed on 56 patients (average age 52.3 years, range 20–82 years, women = 40) from 2005 to 2019. All procedures were performed in an outpatient endoscopy suite. Five patients were lost to follow-up. At 6-month follow-up, 21/51 patients (41%) successfully reduced their PPI dosage by at least half. Symptom resolution was determined by percentage decrease of number of symptoms. Thirty-four out of 51 patients reported symptom improvement, averaging a 78.5% decrease in number of symptoms. The average symptomatic improvement was a 54% decrease in number of symptoms. One patient who had decrease in 1 out of 3 symptoms underwent a second Stretta and had full response after the subsequent procedure. Seventeen patients experience no improvement. Two of these 17 patients underwent a second procedure without improvement. There were no reported long-term procedure-related complications. CONCLUSION: The Stretta procedure can help patients with severe refractory GERD. In our review, two-thirds of patients had meaningful improvement in symptoms. More than two-fifths of patients were able to reduce their PPI dosage. No long-term procedure-related complications were noted. The strength of the review was limited due to the small number of patients and lack of objective markers, such as first-hand HRQoL questionnaires. This can be utilized on future patients to further assess quality of life improvement with the procedure.