On May 5 at Digestive Disease Week a panel of nine gastroenterologists and digestive surgeons presented on radiofrequency therapy, or Stretta, as a treatment for gastroesophageal reflux disease. The panel was moderated by Professor. Jan Tack of Leuven, Belgium and speakers included:
• Professor Mohammed Al Quaiz, MD, Riyadh, Saudi Arabia
• Professor Serhat Bor, MD, Izmir, Turkey
• Kenneth Chang, MD, Irvine, California
• Professor Guido Costamagna, MD, FACG, Rome, Italy
• Brian Dunkin, MD, FACS, Houston Texas
• Ronnie Fass, MD, Cleveland, Ohio
• Mark Noar, MD, MPH, Towson, Maryland
• George Triadafilopoulos, MD, Palo Alto, California
"This is not a novel therapy," said Professor Tack. "There are more than 100 papers on Stretta." The panel discussed the responses of a Delphi panel of 28 GERD experts across nine countries on topics including:
• Top priorities of GERD treatments
• Unmet needs in GERD treatment
• Safety and efficacy of Stretta
• Patient selection for Stretta
• Where Stretta belongs in overall GERD treatment
The panel of GERD experts reached consensus that the control of symptoms is the primary outcome goal of the treatment of GERD. The physicians on the DDW panel also reached consensus using the Delphi method that normalization of pH is not a primary goal of GERD treatment. "Controlling pH is important, but absolute normalization need not happen," said Dr. Fass. The panel overall agreed that pH is not the only cause of acid symptoms and not the only measure of overall GERD treatment success.
The Delphi panel reached a majority consensus, 92 percent, that Stretta fills an unmet need in GERD treatment. Professor Al Quaiz discussed undergoing his own successful Stretta procedure and the impact it had on his life. "For me, it was a life changing event," he said.
The physicians of the DDW panel eventually defined Stretta as a "middle therapy." "As a surgeon I enjoy the concept of a continuum of care," said Dr. Dunkin. "If you are trying to do more than medicate, but something less invasive than surgery, Stretta fills that role."
The Delphi panel reached 100 percent consensus — that the Stretta procedure improves the quality of life as well. "Patients can stop using the CPAP machine, eat normally and sleep through the night," said Dr. Noar. "Those are objective measures and you can see quality of life is improved."
The entire Delphi panel was also in consensus that the procedure was considered safe in the hands of an experienced physician. The DDW panel physicians concurred. "This is by far the safest middle ground between medication and surgery," said Dr. Chang.
The DDW panel physicians acknowledged that Stretta does have a learning curve, but is overall a safe procedure. "Learn it on paper first and then go to an experienced education center," said Professor Bor.
"I run an education center," said Dr. Dunkin. "This is not a technically challenging procedure; it is a procedure that requires attention to detail."
Dr. Noar recently published the 10-year outcomes data on the procedure and the DDW panel physicians discussed Stretta's efficacy and long length of effect. The majority of the Delphi panel of GERD experts, 81.9 percent, concluded that Stretta was a good long-term option for the management of GERD.
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