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Stretta Therapy, a non-ablative radiofrequency treatment for GERD, was called “effective, safe and durable following 15 years of worldwide use” and cited as a “viable complement or alternative to medical and surgical treatment” in a newly-published clinical review of endoscopic techniques for gastroesophageal reflux disease (GERD). Authors Wai-Kit Lo, MD, MPH and Hiroshi Mashimo, MD, PhD of Harvard Medical School, examined multiple alternatives to PPI therapy or surgery, including Stretta and other devices such as endoscopic plication and suturing, as well as injectable and implantable bulking agents. Their findings have been published in the Journal of Clinical Gastroenterology.
ABOUT GERD AND ENDOSCOPIC TREATMENTS
GERD affects an estimated 20 percent of adults, and although PPI therapy is the accepted standard of care, there are approximately 40 percent of patients who still experience symptoms despite PPI treatment. The authors explain that the main anatomic and neuromuscular defects underlying GERD are not addressed by PPIs. They also recognize a rising awareness of adverse effects associated with long-term PPI use and a decline in the volume of surgical fundoplication, noting that these factors underscore the need for alternative approaches to complement medical and surgical treatments.
There are several endoscopic techniques available. However, recognizing that data about these therapies has been mixed, the authors undertook a critical assessment of these technologies to better understand the role that they play in the management of GERD symptoms.
THE WEALTH OF RESEARCH ON STRETTA
In their evaluation of treatments, authors noted that Stretta has the longest period of clinical evaluation, observing that Stretta data includes a meta-analysis of 1,441 patients across 18 studies, and four randomized-controlled trials. They referenced that Stretta earned the strongest grade recommendation by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) in guidelines forendoluminal treatment of GERD in 2013. They also reported that newer studies show that the effect of Stretta remains durable at eight and 10 years after initial therapy. Additionally, recent guidelines from the ASGE came out in support of a consideration of endoscopic treatments for GERD.
Regarding Stretta, the authors concluded that, “A wealth of research has demonstrated the safety, efficacy, durability, and repeatability of Stretta treatment. Most important, it does not preclude alternative treatments including medical, surgical, or repeat radiofrequency treatments, and may also provide potential treatment for patients who have failed fundoplication. Stretta is likely the least expensive alternative to medical therapy. This technique should be considered a viable complement or alternative to medical and surgical treatment of GERD symptoms.”