Gastro esophageal reflux disease is a common problem in Gastroenterology practice.we have excellent proton pump inhibitors and in this part of the Globe they are very cost effective and relatively safe for long term use as once daily dose or twice.On the other hand all minimal access surgeons are very familiar with Laparoscopic Anti Reflux Surgery(LARS) and its efficacy .The relatively new therapeutic modality is Radio Frequency Energy application.It is Non invasive endoscopic modality but most of the procedure is done without vision.
Stretto was introduced in 1990 along other non surgical procedures like endocynch
entyryx etc,but then all these became obsolete due to their failures.now there is resurgence of street a,but this procedure is the last resort in the treatment armament optimum after PPI and Fundoplication.only in selected group of patients this procedure is valid.
Prasanna, check this 2008 article from Ohio state,
they where advocates to this procedure in 2004, but had no longterm followup.
Radiofrequency energy delivery to the lower esophageal sphincter (Stretta procedure) does not provide long-term symptom control.
Dundon JM, et al. Surg Innov. 2008.
Dr Reddy
Two decades ago, publications concerning Stretta as treatment of GERD were numerous. They found that this treatment has limitations for long term therapy of GERD. Radiofrequency (Stretta) reduced symptoms, nevertheless there were no modification of pH monitoring of esophagus in 24 h. In addition studies were performed with highly selected patients since in many of them, those with hiatal hernia and erosive esophagitis were excluded.
In my opinion Stretta may be reserved to symptomatic patients in spite of PPI, with moderate GERD , without hiatal hernia who refuses funduplication. With these criteria few patients may recieve this method
Thankyou,sleeve gastrectomy has become a a popular procedure in Bariatrics.The incidence of reflux is higher in sleeve where a non surgical modality like stretta probably has a role,as mentioned by Dr Deigio few may receive this treatment.
Stretta seems to be a fundamentally flawed procedure to me without logic or adequate long term results