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Stretta Procedure Can Eliminate GERD

By Tracy Denninger

Radio-frequency stimulation to lower esophageal sphincter muscle and gastric cardia is well tolerated by older adults.

Stretta, a minimally invasive outpatient procedure eligible for Medicare reimbursement, provides a safe way for patients with gastroesophageal reflux disease (GERD) to potentially eliminate the condition’s unwanted effects and avoid a lifetime of taking medication.

The reasons vary, but patients who have undergone the procedure are ecstatic about the results, says Gary Reiss, MD, a gastroenterologist at the Louisiana State University Health Sciences Center in New Orleans. “They’re happy to have one less pill to take, especially since many patients take multiple medications. They’re happy because they can eat normally and not be woken up at night with symptoms ranging from heartburn to throat and sinus irritation and even, in some cases, sleep apnea."

The Procedure
Performed endoscopically, the Stretta procedure, which has been available for roughly a decade, involves applying radio-frequency stimulation to the lower esophageal sphincter muscle and gastric cardia. The physician then inflates a balloon, deploys needle electrodes that deliver the radio-frequency energy, and removes the device. As a result of the treatment, the muscle elongates, thickens, and remodels, limiting the amount of acid that backs up into the esophagus, according to Reiss. “It’s a simple procedure to perform,” he says. “There’s a low risk profile, and it’s well tolerated.”

Because “geriatric patients aren’t as robust when it comes to surviving a major surgical procedure,” Reiss says the procedure can be a good option for older adult patients.

Reiss says the reason patients often express interest in the Stretta procedure is not because their proton pump inhibitor (PPI) medication, a standard once-a-day treatment for GERD, isn’t producing results but because they’re concerned about the medication’s side effects, especially with long-term use. He notes that roughly one-third of patients taking a PPI medication experience no symptom relief, but for those who do, over the long term there can be issues with calcium or magnesium malabsorption and osteoporosis, for example, which is of particular concern to older patients.

Identifying Candidates
While Stretta is a good option for many GERD patients, they first must be identified as acceptable candidates for it. This means performing appropriate testing to ascertain whether they actually have acid reflux. “We need to make sure there’s not another condition [present contributing to GERD],” Reiss explains. “For example, some patients aren’t always taking their medication as prescribed, 15 to 30 minutes before a meal.”

Additionally, if patients have a large hiatal hernia or a motility issue that’s causing their symptoms, they may be better surgical candidates, according to Reiss.

If such issues are eliminated as possible GERD causes, patients undergo a standard endoscopy to confirm they don’t have a precancerous condition, which also would preclude them from undergoing the Stretta procedure. If no such condition is present, the procedure, performed under monitored anesthesia, takes roughly 45 minutes to complete, according to Reiss. Following the procedure, patients spend about four hours recuperating, after which they’re sent home with appropriate pain medication, as some may experience mild transient abdominal or chest pain or discomfort.

Patients follow a soft-foods diet for approximately one week after the procedure, with most usually up and moving around normally the day after the procedure, Reiss says.

Success Rate
About 90% of Stretta procedures are successful, though “a small subset of patients can get a repeat procedure, if necessary, and they are still candidates for other interventions should they be needed,” Reiss explains.

Outcomes of the procedure are measured by tests such as GERD quality of life or esophageal acid scores, with patients ultimately reducing or eliminating acid-suppressing medications if the procedure has been successful. Reiss says it takes about three months for patients to experience full results, with most patients reducing or eliminating their medications after about eight weeks.

Reiss recommends that physicians with geriatric patients who are suffering with GERD symptoms refer their patients to a gastroenterologist for evaluation to determine whether they’re candidates for Stretta. “It’s a very safe, easy procedure for geriatric patients to handle,” he says. “Really, when you look at their options before Stretta was available, there was only a surgical intervention. They have more options now.”

— Tracy Denninger is the senior production editor at Today’s Geriatric Medicine.