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Fifteen Plus Years After Stretta Antireflux Endoscopy Procedure: Quality of Life and PPI Requirements


Reymunde, Alvaro MD; Santiago, Nilda MD

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American Journal of Gastroenterology: October 2017 - Volume 112 - Issue - p S459-S460
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Introduction: Radiofrequency energy (Stretta) has been used for years to effectively treat patients either with poor response to PPI's or medication side effects or in patients who worry about its long time use. The aim of this study is to assess the long term efficacy of the Stretta endoscopy antireflux procedure among our first patients done between 2000-2001 regarding quality of life and the use and frequency of PPI's, as well as the development of Barrett's or neoplasia in the esophagus.

Methods: A total of 35 patients from our initial experience between 2000 and 2001 who had continuous follow up at least once a year at our institution were included. Prior to Stretta, all of them had either partial response to PPI's or good control but with side effects or with worries about possible long term side effects. The 35 patients underwent validated health related QOL questionnaires for heartburn and regurgitation, as well as upper endoscopy. Twenty of the patients also underwent 48 hr Bravo pH monitoring. Our primary goal was to asses QOL after 15 years of the procedure and our secondary points was to assess the need and frequency of PPI's and in those with pH data (Bravo test) to assess the presence of reflux

Results: The mean QOL at base line (2000-2001) was 2.4 and 3.9 at 15 years (p <.001), the mean GERD symptoms score at baseline was 2.7 and 1.1 at 15 years (p <.01), originally the daily use of PPI was 100% of the patients and in 50% the use was twice a day. At 15 years follow up none of the patients were on twice a daily PPI or in a daily basis. Ten patients were on anti-secretory medications in an on demand basis, 6 were on over the counter histamine blocker and 4 on over the counter PPI's. The Bravo 48 hour pH recordings in the 20 patients were at 4.5 De Meester score. None of the 35 patients had evidence of Barrett's or esophageal neoplasia on endoscopy 15+ years later.

Conclusion: Stretta is a safe and long lasting endoscopic therapy for GERD wit results remaining over 15 years, especially in this sub group of selected patients with partial response to PPI's or good response to PPI's, but with side effects or concerns or long term medications use.

© The American College of Gastroenterology 2017. All Rights Reserved.