Radiofrequency treatment for gastroesophageal reflux disease
- George Triadafilopoulos, MD
George Triadafilopoulos, MD
- Clinical Professor of Medicine
- Stanford University School of Medicine
Standard therapy for gastroesophageal reflux disease (GERD) involves behavioral modifications and treatment with medications that reduce acid production or improve esophageal motility. Open or laparoscopic Nissen fundoplication may be chosen for those patients who do not wish to remain on an antisecretory medication, have an inadequate response to antisecretory medication, have a large hiatal hernia, or have persistence of esophagitis on medication. Esophagitis and GERD symptoms are improved or resolved after fundoplication in 76 to 98 percent of patients, while esophageal acid exposure time is normalized in approximately 90 percent of patients. (See "Surgical management of gastroesophageal reflux in adults".)
Minimally invasive alternatives to standard antireflux surgery have been developed, and include :
●Plication of tissues in the lower esophageal region with sutures, transmural fasteners, or staples that are placed during endoscopy (EndoCinch, EsophyX) .
●Injection of a biopolymer into the lower esophageal sphincter (Enteryx). However, the procedure has been associated with severe complications, including pneumomediastinum, embolization of the polymer leading to renal failure, esophageal stenosis, and a death due to intra-aortic injection of the polymer. Because of these complications it was recalled in 2005.
●Application of controlled radiofrequency (RF) energy to the lower esophageal sphincter region (Stretta procedure). An advantage of RF treatment is that it can be used in patients with challenging anatomy .
Subscribers log in hereLiterature review current through: Jul 2017. | This topic last updated: Jul 22, 2015.References
- Utley DS, Kim M, Vierra MA, Triadafilopoulos G. Augmentation of lower esophageal sphincter pressure and gastric yield pressure after radiofrequency energy delivery to the gastroesophageal junction: a porcine model. Gastrointest Endosc 2000; 52:81.
- Jafri SM, Arora G, Triadafilopoulos G. What is left of the endoscopic antireflux devices? Curr Opin Gastroenterol 2009; 25:352.
- Tam WC, Schoeman MN, Zhang Q, et al. Delivery of radiofrequency energy to the lower oesophageal sphincter and gastric cardia inhibits transient lower oesophageal sphincter relaxations and gastro-oesophageal reflux in patients with reflux disease. Gut 2003; 52:479.
- Arts J, Sifrim D, Rutgeerts P, et al. Influence of radiofrequency energy delivery at the gastroesophageal junction (the Stretta procedure) on symptoms, acid exposure, and esophageal sensitivity to acid perfusion in gastroesophagal reflux disease. Dig Dis Sci 2007; 52:2170.
- Arts J, Bisschops R, Blondeau K, et al. A double-blind sham-controlled study of the effect of radiofrequency energy on symptoms and distensibility of the gastro-esophageal junction in GERD. Am J Gastroenterol 2012; 107:222.
- Triadafilopoulos G. Changes in GERD symptom scores correlate with improvement in esophageal acid exposure after the Stretta procedure. Surg Endosc 2004; 18:1038.
- Noar MD, Noar E. Gastroparesis associated with gastroesophageal reflux disease and corresponding reflux symptoms may be corrected by radiofrequency ablation of the cardia and esophagogastric junction. Surg Endosc 2008; 22:2440.
- http://www.sages.org/publications/guidelines/endoluminal-treatments-for-gastroesophageal-reflux-disease-gerd/ (Accessed on July 15, 2013).
- Triadafilopoulos G, DiBaise JK, Nostrant TT, et al. The Stretta procedure for the treatment of GERD: 6 and 12 month follow-up of the U.S. open label trial. Gastrointest Endosc 2002; 55:149.
- Richards WO, Houston HL, Torquati A, et al. Paradigm shift in the management of gastroesophageal reflux disease. Ann Surg 2003; 237:638.
- Wolfsen HC, Richards WO. The Stretta procedure for the treatment of GERD: a registry of 558 patients. J Laparoendosc Adv Surg Tech A 2002; 12:395.
- Torquati A, Houston HL, Kaiser J, et al. Long-term follow-up study of the Stretta procedure for the treatment of gastroesophageal reflux disease. Surg Endosc 2004; 18:1475.
- White B, Jeansonne LO, Cook M, et al. Use of endoluminal antireflux therapies for obese patients with GERD. Obes Surg 2009; 19:783.
- Perry KA, Banerjee A, Melvin WS. Radiofrequency energy delivery to the lower esophageal sphincter reduces esophageal acid exposure and improves GERD symptoms: a systematic review and meta-analysis. Surg Laparosc Endosc Percutan Tech 2012; 22:283.
- Lipka S, Kumar A, Richter JE. No evidence for efficacy of radiofrequency ablation for treatment of gastroesophageal reflux disease: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2015; 13:1058.
- Corley DA, Katz P, Wo JM, et al. Improvement of gastroesophageal reflux symptoms after radiofrequency energy: a randomized, sham-controlled trial. Gastroenterology 2003; 125:668.
- Aziz AM, El-Khayat HR, Sadek A, et al. A prospective randomized trial of sham, single-dose Stretta, and double-dose Stretta for the treatment of gastroesophageal reflux disease. Surg Endosc 2010; 24:818.
- Triadafilopoulos G, Dibaise JK, Nostrant TT, et al. Radiofrequency energy delivery to the gastroesophageal junction for the treatment of GERD. Gastrointest Endosc 2001; 53:407.
- Velanovich V. Comparison of symptomatic and quality of life outcomes of laparoscopic versus open antireflux surgery. Surgery 1999; 126:782.
- DiBaise JK, Brand RE, Quigley EM. Endoluminal delivery of radiofrequency energy to the gastroesophageal junction in uncomplicated GERD: efficacy and potential mechanism of action. Am J Gastroenterol 2002; 97:833.
- Liu HF, Zhang JG, Li J, et al. Improvement of clinical parameters in patients with gastroesophageal reflux disease after radiofrequency energy delivery. World J Gastroenterol 2011; 17:4429.
- Dughera L, Rotondano G, De Cento M, et al. Durability of Stretta Radiofrequency Treatment for GERD: Results of an 8-Year Follow-Up. Gastroenterol Res Pract 2014; 2014:531907.
- Noar M, Squires P, Noar E, Lee M. Long-term maintenance effect of radiofrequency energy delivery for refractory GERD: a decade later. Surg Endosc 2014; 28:2323.
- Liang WT, Wang ZG, Wang F, et al. Long-term outcomes of patients with refractory gastroesophageal reflux disease following a minimally invasive endoscopic procedure: a prospective observational study. BMC Gastroenterol 2014; 14:178.
- Richards WO, Scholz S, Khaitan L, et al. Initial experience with the stretta procedure for the treatment of gastroesophageal reflux disease. J Laparoendosc Adv Surg Tech A 2001; 11:267.
- Houston H, Khaitan L, Holzman M, Richards WO. First year experience of patients undergoing the Stretta procedure. Surg Endosc 2003; 17:401.
- Dundon JM, Davis SS, Hazey JW, et al. Radiofrequency energy delivery to the lower esophageal sphincter (Stretta procedure) does not provide long-term symptom control. Surg Innov 2008; 15:297.
- Liang WT, Wu JN, Wang F, et al. Five-year follow-up of a prospective study comparing laparoscopic Nissen fundoplication with Stretta radiofrequency for gastroesophageal reflux disease. Minerva Chir 2014; 69:217.
- Perez AR, Moncure AC, Rattner DW. Obesity adversely affects the outcome of antireflux operations. Surg Endosc 2001; 15:986.
- Morgenthal CB, Lin E, Shane MD, et al. Who will fail laparoscopic Nissen fundoplication? Preoperative prediction of long-term outcomes. Surg Endosc 2007; 21:1978.
- Go MR, Dundon JM, Karlowicz DJ, et al. Delivery of radiofrequency energy to the lower esophageal sphincter improves symptoms of gastroesophageal reflux. Surgery 2004; 136:786.
- Gersin K, Fanelli R. The Stretta procedure: Review of catheter and technique evolution, efficacy and complications 2 years after introduction. Surg Endosc 2002; 16 (Suppl 1):PF199.
- Chen D, Barber C, McLoughlin P, et al. Systematic review of endoscopic treatments for gastro-oesophageal reflux disease. Br J Surg 2009; 96:128.
- Lutfi RE, Torquati A, Richards WO. Endoscopic treatment modalities for gastroesophageal reflux disease. Surg Endosc 2004; 18:1299.
- Comay D, Adam V, da Silveira EB, et al. The Stretta procedure versus proton pump inhibitors and laparoscopic Nissen fundoplication in the management of gastroesophageal reflux disease: a cost-effectiveness analysis. Can J Gastroenterol 2008; 22:552.
- Funk LM, Zhang JY, Drosdeck JM, et al. Long-term cost-effectiveness of medical, endoscopic and surgical management of gastroesophageal reflux disease. Surgery 2015; 157:126.