The Stretta Surgical Procedure for GERD

By Patricia Raymond, Michelle Beaver

The Stretta radiofrequency system, approved by the Food and Drug Administration (FDA) in 2000 for treating gastroesophageal reflux disease (GERD), uses radiofrequency (RF) energy to increase collagen contraction at the sphincter and to decrease nerve sensitivity to acid at the lower end of the esophagus. It’s sort of like cooking the lower esophagus and esophageal sphincter via microwaves.

The gastroenterologist does an upper endoscopy (technically called an esophagogastroduodenoscopy, or EGD) and measures the distance from the person’s teeth to the junction of the esophagus and stomach. Then the gastroenterologist withdraws the endoscope and inserts the RF catheter.

This complicated catheter is a 4-foot-long slender tube that has an inflatable balloon at the end. Four additional slender catheters run down the central catheter’s sides and end alongside the balloon. The peripheral tubes have retractable short needles.

The balloon is inflated to press the needle tubes against the esophageal lining, the needles are advanced out, and then the gastroenterologist “cooks” the esophagus in those areas using RF through the needles for about a minute. The needles are retracted, the balloon is deflated, and the catheter is repositioned to a different level in the esophagus. Usually, a patient gets about 60 total zaps over about 30 minutes.

The Stretta procedure has a long track record. The ten-year data, released in 2013, were good, but not perfect. Of the 99 study participants with refractory GERD followed for ten years, 41 percent no longer required the medications they were taking pre-Stretta. That means 59 percent were still on meds.

Stretta is not complication free, but it’s pretty safe. Serious complications — such as esophageal perforation and aspiration pneumonia — have been reported, but complications were mainly modest in more than 1,400 patients participating in 20 studies. The most common complications were temporary upper abdominal pain in 66 percent of patients, chest pain in 15 percent, ulcers in the esophagus in 4 percent, and difficult or painful swallowing in 3 percent.