1. A prospective study of endoscopic radiofrequency application (STRETTA) for gastroesophageal reflux disease: Early UK experience
N Hamza, D Kamali, S Punnoose, A Dhar, A Reddy, YKS Viswanath
Department of Surgery, James Cook University Hospital, Middlesbrough, United Kingdom
Introduction
Radiofrequency application (RFA) is considered appropriate therapy for patients with gastroesophageal reflux disease (GERD) (SAGES 2013)
It produces symptomatic relief in patients with GERD (UK NICE guidance 2013)
Aim k
The objective of the current study is to present our early UK experience of patients undergoing RFA for GERD
Methods & procedures
A prospective study
All patients underwent upper gastrointestinal endoscopy and barium meal as part of preoperative work up
Transoral device to deliver RFA to the oesophageal wall at the GOJ, under sedation or GA
30-mm diameter balloon with 4 electrodes to generate a tissue temperature of 65oC to 85oC during a series of one-minute treatment cycles (Fig 1, 2)
Data presented as median (interquartile range, IQR)
Fig 2: Endoscopic appearance pre and post RFA
Endoscopic and post-RFA outcomes:
Hiatus hernia (<2cm)
6/19 (32%)
Anesthesia:
General
Conscious sedation
8/19
11/19
RFA was delivered at all 6 levels in all patients with a median (IQR) of 50 (44-54), out of possible 56, treatment points achieving more than 30 seconds cycle
Postoperative complications
0 (0%)
Follow up
4 (2-6) months
Post-RFA GERD score*:
Heartburn
Dysphagia
Regurgitation
1 (0-1)
0 (0-1)
0 (0-2)
Results
Preoperative characteristics:
Study period
Oct 14 - Aug 15
Number of patients 19
Sex: Female (%)
12/19 (63%)
Age (year)
62 (52-65)
Previous antireflux surgery
4/19 (21%)
Pre-RFA GERD score*:
Heartburn
Dysphagia
Regurgitation
4 (3.5-4)
2 (0-4)
4 (3-4)
*(0=no symptoms, 1=symptoms noticeable but not bothersome, 2= symptoms bothersome but not every day, 3=symptoms bothersome every day, 4=symptoms affect daily activity, and 5=incapacitating symptoms)
Conclusion
RFA is feasible and safe in the treatment of symptomatic GERD
In short term, it achieves symptomatic relief in the majority of patients
In patients with poor response to medical therapy, it can be considered as an alternative option to surgery in those who are unfit for surgical intervention
Long term follow up is essential to appraise the durability of these favourable outcomes
*(0=no symptoms, 1=symptoms noticeable but not bothersome, 2= symptoms bothersome but not every day, 3=symptoms bothersome every day, 4=symptoms affect daily activity, and 5=incapacitating symptoms)
(Fig 1: Balloon with four 5.5-mm retractable stylet electrodes delivering a series of one-minute treatment cycles