You make an interesting point about efficacy, but if we look at the 10 year papers on both technologies, results are the same at that point. Stretta has suffered from a number of issues that include: 1) poor capitalization of the companies who have owned the technology, compared to larger computing companies, leading to inability to offer sufficient financial incentive to KOL's, 2) reimbursement difficulties in the US which have taken 18 years to overcome and are still present, 3) delayed understanding of mechanism of action, and 4) distraction caused by KOL's presenting misinformation about potential scarring and desensitization or poorly conceived studies designed to malign the technology. Finally, Nissen has been and is more readily paid for in most countries and only requires surgical skill sets and not expensive disposable equipment, often costing more than the cost of the Nissen.

Fully agree on lost points with the answers by Dr Noar. Reimbursement and familiarity are key here.

Also, many patients with GERD have a hiatal hernia that would be repaired during surgery. STRETTA is rather selective but in those patients it can be done, effective.