Generally, a weak or lax lower esophageal sphincter causes reflux, although some reflux is related to inappropriate relaxation of the LES. Historically, antireflux surgical procedures wrap part of the stomach around the LES to tighten or reinforce this region. As mentioned earlier, several techniques have been developed to accomplish this nonoperatively with an endoscope to avoid the risks and discomfort of surgery.
When tissue is damaged, it scars and shortens or contracts and becomes stiffer. When the body repairs a wound, it uses a material it produces called collagen. Collagen in your body provides strength and elasticity to tissues. As you age, for example, collagen breaks down and leads to wrinkles; also, plastic surgeons use collagen injections to treat wrinkles.
A Stretta procedure uses this concept of scarring and collagen production to reinforce the lower esophageal sphincter (see Figure 15). First, the patient is heavily sedated or given general anesthesia and undergoes a regular endoscopy test. Then, the endoscope is removed and a probe is placed in the esophagus at the level of the LES. This tool has several needles sticking out to pierce the wall of the esophagus.When in place, radiofrequency energy (like that used in a microwave oven) is passed down the probe and out the needles into the esophageal wall. This causes the local temperature of the tissues to increase, virtually to the point of “cooking” or damaging the area. The probe is repositioned several times, and the procedure of radiofrequency ablation is repeated until the whole LES is treated. Overall, this takes 30 to 60 minutes. The result is, hopefully, uniform damage to the LES, which heals over time with scarring and increased collagen production, which thereby tightens the LES.
Several studies have examined patients who have had Stretta procedures. Most patients were able to stop or reduce their use of proton pump inhibitor medication. Most patients would recommend this procedure to a friend or undergo the procedure again. In a small study of patients, pH studies demonstrated an improvement in the amount and duration of acid in the esophagus. Complications of the procedure include chest pain requiring narcotics, damage to the lining of the esophagus, and difficulty swallowing. In the first 6 months of use, four perforations of the esophagus (a hole through the esophageal wall) and two deaths from aspiration pneumonia occurred. The overall serious complication rate is about 1 in 400.
Generally, radiofrequency ablation or Stretta is for patients who have failed to improve with medication and who do not want or cannot have a surgical repair of the LES. Stretta is not suitable for those patients with large hiatal hernias. It is a fairly new procedure and the long-term risks and benefits and ability to stay off medication really are unknown. Stretta is FDA approved and is currently available.
By Mortin - Copyright 2009
Last modification 31/12/2009
What is a Stretta Procedure? References