A non surgical intervention for those with symptoms that are uncontrolled with medication alone.
Page reviewed by: Mr Nicholas Boyle BM MS FRCS 03/07/20
Stretta therapy is a minimally invasive method of reducing the symptoms of GORD (Gastro Oesophageal Reflux Disease) which will allow the majority of patients to remove or majorly lessen the need for PPIs (Proton Pump Inhibitors). Stretta is performed endoscopically usually while under sedation. Some patients would prefer to avoid an operation or they are not fit for general anaesthetic, therefore Stretta provides an option that lies between medication and surgery.
The procedure is performed as an outpatient procedure takes less than an hour and allows patients to get back to their day-to-day activities 24 hours following the procedure. Unlike LINX®, Fundoplication and EndoStim, Stretta Therapy doesn’t require any incisions, implants or stitching. As this is an invasive procedure it does carry a small risk. It is safe overall though with a low complication rate of approximately 1%.
Scientific research suggests that Stretta can improve a patient’s reflux symptoms, reducing dependency on anti-acid medications. Though the effectiveness of the procedure seems to diminish over time, its persistent effects have been described to last up to 10 years after the procedure in appropriately selected patients.
Overall, it would appear that Stretta is more effective than PPIs (Proton Pump Inhibitors) but less effective than surgery.
Patients with a moderately large Hiatus Hernia, severe oesophagitis or Barrett’s oesophagus should note that Stretta is not indicated for them.
How the procedure works remains unclear. Radiofrequency (RF) energy is emitted by the Stretta system to the muscle present in between the stomach and oesophagus. It heats the tissue to 85°c. This reworks and improves the muscle tissue there and results in reducing sensitivity to acid and, in turn, reduces the event of reflux. This treats the problem that may be the source of GORD (Gastro Oesophageal Reflux Disease) without performing surgery. The effect does take some time to develop and is unpredictable, occurring faster in some patients than others. A reduction in reflux symptoms can take between 2-12 months following the procedure. Due to this, PPIs (Proton Pump Inhibitors) are reduced slowly, starting 2 months following surgery.
Radiofrequency energy is waveform energy that is present in a great deal of medical procedures, including the following:
Stretta therapy has been studied the most in terms of treatments for GORD (Gastro Oesophageal Reflux Disease) and in over 40 clinical studies and 25,000 procedures it has proven to be a safe and effective treatment option. These studies also show that relief from the symptoms of reflux last from 4-10 years.
According to a review article by The Society of American Gastrointestinal and Endoscopic surgeons (SAGES) published in May 2017: CLINICAL SPOTLIGHT REVIEW: ENDOLUMINAL TREATMENTS FOR GASTROESOPHAGEAL REFLUX DISEASE (GERD)
“Based on existing evidence, Stretta significantly improves health related quality of life score, heartburn scores, the incidence of esophagitis, and esophageal acid exposure in patients with GERD, but does not increase lower esophageal sphincter basal pressure. In addition, it decreases the use of PPIs by approximately 50%. The effectiveness of the procedure diminishes some over time, but persistent effects have been described up to 10 years after the procedure in appropriately selected patients with GERD. Stretta is more effective than PPIs, but less so than fundoplication. Stretta is safe in adults and has a short learning curve.”
How long does the Stretta Procedure take?
The Stretta Procedure is designed to take less than one hour. Patients arrive 30 minutes to an hour before the procedure and are typically able to go home with the help of a relative or friend about an hour after the procedure is completed.
What kind of anaesthesia is used in the Stretta Procedure?
Patients receive conscious sedation during the procedure. Under conscious sedation, the patient will feel very little of the intervention. In most cases the patient is comfortable and will remember little about the procedure upon awakening.
Is this Stretta procedure considered surgery?
The Stretta Procedure is a non-surgical procedure. The procedure is performed through the mouth and the oesophagus, involves no cutting or sewing, and leaves no skin incisions or scars.
What can I expect in terms of my GORD symptom improvement after the Stretta procedure?
Most patients experience reduction in heartburn and regurgitation symptoms within one month of the procedure, and are able to discontinue drug therapy with minimal residual symptoms. Your individual results may vary.
Will I have to continue taking GORD medication after the Stretta Procedure?
Most patients who have the Stretta procedure have been able to discontinue their reflux medications within two months of the procedure and symptoms continue to improve during the 6 months following the procedure.