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Gastro-oesophageal reflux disease
Published in Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven, Succeeding in Paediatric Surgery Examinations, 2017
Minimally invasive antireflux proceduresLaparoscopic Nissen fundoplicationEndoCinch procedureStretta procedureSubmucosal injection of DurasphereTIF with EsophyXIntersphincteric injection of muscle-derived cells
Gastroesophageal reflux in the neonate and small infant
Published in Prem Puri, Newborn Surgery, 2017
In the last few years, a number of new technical methods have been introduced for the treatment of reflux in adults, such as creation of a mucosal fold by an intraluminal stapler, radio-wave damage of the cardia (Stretta procedure), or endoscopic submucosal injection of foreign material (Enteryx). Experiences in children are rare, and long-term results are lacking43–46
Acid-related diseases
Published in Nizar Zein, Bret Lashner, The Year in Gastroenterology and Hepatology, 2005
I N T E R P R E T A T I o N The study by Corley e t a / . is the only attempt to date to study any of these techniques with a sham control. Sixty-four GERD patients were randomly assigned to radio frequency energy treatment (Stretta) or a sham procedure and followed for 6 months. Although heartburn symptoms (P = 0.05) and GERD quality of life (P = 0.03) significantly improved with radio frequency treatment, there were no differences in daily medication use or In oesophageal acid exposure times (Fig. 1.4).There were no perforations or deaths. Harewood and Gostout performed a decision analysis to compare the costs of endoluminal gastroplication or the Stretta procedure with PPI treatment of GERD, using a costmin~mlzatlon approach. For patients with symptoms easily controlled on single daily PPI dosing, endotherapy offers no cost advantage. In patients requiring twice-daily doses of PPls, endotherapy proves t o be the most economical strategy for a limited window between 1 7 and 2 9 months. Sensitivity analysis revealed that a PPI remains the most economical option beyond 3 years, provided annual endotherapy failure rates remain greater than 20%.
The safety and efficacy of peroral endoscopic cardial constriction in gastroesophageal reflux disease
Published in Scandinavian Journal of Gastroenterology, 2022
Wenxi Jiang, Guangwu Chen, Caijuan Dong, Shefeng Zhu, Jiaqi Pan, Zhaoxue Liu, Meng Li, Chaohui Yu, Zhe Shen
For patients who do not have severe reflux esophagitis (LA grade C or D) or hiatal hernias >2 cm, endoscopic anti-reflux technology has been proposed as an alternative to surgery and to long-term PPI treatment. GERD usually occurs during transient lower esophageal sphincter relaxation with low lower esophageal sphincter pressure [24]. Stretta is a form of radiofrequency ablation to the lower esophageal sphincter and cardia. The mechanism may be related to the induction of hypertrophy and fibrosis of lower esophageal sphincter as well as neurolysis [25]. A study showed PPI-refractory patients with GERD had heartburn symptoms and GERD health-related quality of life scores greatly decreased after Stretta procedure [26]. However, another meta-analysis holds the opposite view [25]. ARMS is also a minimally invasive endoscopic procedure for treatment of GERD by mucosa resection on the lesser curvature mucosa of the cardia. It suppresses acid backflow by narrowing the reflux window and enhancing the flap valve due to contraction of the scar tissue [8]. It was reported ARMS resulted in similar reflux quality of life outcomes compared to Nissen fundoplication whereas the incidence of dysphagia and stenosis ranged from 6.1% to 14.4% [27].
Surgical treatment of therapy-resistant reflux after Roux-en-Y gastric bypass. A case series of the modified Nissen fundoplication
Published in Acta Chirurgica Belgica, 2020
Jan Colpaert, Julie Horevoets, Leander Maes, Gilles Uijtterhaegen, Bruno Dillemans
For these patients with persisting GERD after bariatric surgery and despite optimal medical therapy there is no clear consensus on further treatment options. To the best of our knowledge only two surgical case reports have been published on surgical intervention with either a conversion to a Belsey Mark IV fundoplication [9] or a fundoplication using the remnant stomach [10]. Both techniques had excellent short postoperative outcomes. Other techniques using the MUSE system™, Stretta Procedure™ and Esophyx™ are all proposed emerging endoluminal therapies or the magnetic Linx device™ have no clear available data on their outcomes [8].
Endoscopic management of refractory gastroesophageal reflux disease
Published in Scandinavian Journal of Gastroenterology, 2018
Waseem M. Seleem, Amr Shaaban Hanafy, Samir I. Mohamed
The application of controlled radiofrequency energy to the LES (Stretta procedure) which operates at 465 MHz and 5 Watt with a treatment range of 65–85 °C in the muscularis propria, while the maximum mucosal temperature is 49 °C due to constant chilled irrigation of the esophageal and cardiac mucosa that keeps mucosal temperature below 35 °C. Stretta procedure caused a significant improvement in the esophageal pH, reduced number of TLESRs and medications used, however when compared to our maneuver; it is still invasive, not cost-effective with rare but significant side effects as gastroparesis, esophageal perforations [28].