First year experience of patients undergoing the Stretta procedure

被引:49
作者
Houston, H [1 ]
Khaitan, L [1 ]
Holzman, M [1 ]
Richards, WO [1 ]
机构
[1] Vanderbilt Univ, Med Ctr, Dept Surg, Nashville, TN 37232 USA
来源
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES | 2003年 / 17卷 / 03期
关键词
gastroesophageal reflux disease; radiofrequency energy; Stretta procedure;
D O I
10.1007/s00464-002-8923-6
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background: The Stretta procedure is a new, totally endoscopic treatment for GERD, where radiofrequency energy is delivered to the smooth muscle of the gastroesophageal junction. Methods: Forty-one patients undergoing the Stretta procedure between August 2000 and August 2001 were prospectively evaluated. Under an IRB-approved protocol, patients were studied preoperatively and postoperatively with esophageal manometry, 24-h pH testing, SF12 surveys, and GERD-specific questionnaires (QOLRAD). Results: Results are reported as mean +/- SEM. All procedures were performed on an outpatient basis; 33 were under conscious sedation and 8 were under general anesthesia. Prior to treatment, patients had a mean LES pressure of 25 +/- 2.4 mmHg, Johnson-Demeester score of 32.8 +/- 4.6 mmHg, and % time reflux 8.4 +/- 0.9%. The quality-of-life scores were significantly improved at 6 months: QOLRAD score increased from 3.7 +/- 0.2 to 5.1 +/- 0.2 (p = 0.002), SF12 mental score increased from 44.3 +/- 2.0 to 51.8 +/- 1.7 (p = 0.001), and SF12 physical score increased from 26.2 +/- 2.4 to 33.1 +/- 3.8 (p = 0.001). Eighteen patients returned for esophageal manometry and 24-h pH testing at a mean of 6.8 +/- 0.5 months. There was a significant decrease in esophageal acid exposure time (8.4 0.9% to 4.4 +/- 1.3%, p = 0.03) and Johnson-Demeester score (32.8 4.6 to 22.9 +/- 5.3, p = 0.04). There was no significant change in mean LES pressure (25.3 +/- 2.4 mmHg to 26.8 +/- 2.6 mmHg, p = 0.63). Twenty of 31 patients (65%) available for 6 months follow-up were completely off proton pump inhibitors. The only complication related to Stretta was a case of gastroparesis 10 days post-operatively that resolved completely. Conclusions: The Stretta procedure is a promising new endoscopic treatment for GERD. It significantly improves GERD symptoms and quality of life while eliminating the need for proton pump inhibitors in the majority of patients.
引用
收藏
页码:401 / 404
页数:4
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