Stretta Procedure

The Stretta procedure is an outpatient endoscopic surgery for the treatment of gastroesophageal reflux disease (GERD), which affects one in 14 American adults. It gives patients a choice for treatments between the long-term use of medications (including proton pump inhibitors) and more invasive surgeries such as the Nissen fundoplication.

According to George Triadafilopoulos, a Clinical Professor of Gastroenterology and Hepatology Medicine at Stanford University Medical Center, the procedure is a minimally invasive, safe, and effective alternative to anti-reflux surgery. It’s ideal for those who aren’t seeing results with medications, are considering surgery, and meet the criteria that would make the procedure safe.

The Procedure

The Stretta procedure takes between 40 minutes and one hour and no hospital stay is required. While the patient is under conscious sedation, the surgeon uses a flexible, disposable catheter connected to a radiofrequency (RF) generator to deliver controlled RF energy to the lower esophageal sphincter (LES) and the gastric cardia in the stomach. This creates thermal legions that will strengthen the LES as they heal and reduce acid reflux events.

Nissen fundoplication provides better control of esophageal acid exposure than the Stretta procedure, but is more invasive. The outcomes of both procedures are comparable in terms of reduction of symptoms, PPI use, and improved quality of life. Maximum benefits usually appear two to six months after the surgery, as the esophagus heals.

Effectiveness of the Stretta Procedure

Several studies have shown that the Stretta procedure can significantly improve both GERD symptoms and quality of life in about two-thirds of patients. There’s a low risk of complications associated with the procedure and no anesthesia or hospitalization is required. Patients can usually return to normal activities within 24 hours of undergoing Stretta.

There have also been no reported cases of dysphagia (difficulty swallowing) following the procedure, which is fairly common after Nissen fundoplication. "Another advantage of the Stretta procedure is that anti-reflux surgery still can be performed in the case of failures," Dr. Triadafilopoulos says.

Who Benefits Most from the Stretta Procedure

GERD is an extremely common medical condition that most patients are able to control with generally safe medications. However, twice-daily proton pump inhibitor therapy proves ineffective in up to 20 percent of patients.

In those cases in which severe reflux can’t be controlled with medications, surgery may be the only option to stop potentially dangerous complications. Complications from acid reflux may include erosive esophagitis, strictures, or Barrett's esophagus.

There is growing clinical evidence that gastroparesis (delayed gastric emptying) may be a factor in many of the cases in which traditional therapies are ineffective. One large study published in Surgical Endoscopy in 2010 found that after six months, Stretta effectively normalized emptying in 74 percent of GERD patients with delayed gastric emptying. After one year, all of the patients had improvement in dyspepsia, health-related quality of life, and heartburn episodes.

Discuss this option with your doctor to see if the Stretta procedure is right for you.