Treatment of Gastroesophageal Reflux Disease After Lung Transplant Using Radiofrequency Ablation to the Lower Esophageal Sphincter (Stretta Procedure)

Background Gastroesophageal reflux disease (GERD) is associated with chronic lung allograft dysfunction after lung transplant. Treating GERD after lung transplant has been shown to improve lung allograft function. This case series describes the efficacy of the Stretta procedure to control GERD after lung transplant at our institution. Methods Eleven patients underwent the Stretta procedure at our institution for GERD after lung transplant during the years 2016-2017. Pre- and post-Stretta reflux parameters were gathered. Pulmonary function was followed up until subsequent fundoplication surgery, death, or end of study observation. Results Reflux on esophagram was noted in 9 patients before Stretta and 8 patients after Stretta. The median number of acid reflux events was 31.5 vs. 26 after Stretta ( P = .95), and median percent time in reflux was 17.7% before vs. 14.5% after Stretta ( P = .76). Median DeMeester score before Stretta was 65.5 (range: 33.2-169.8) vs. 42.5 (range: 19.2-109.8) after the procedure ( P = .14). Median lower esophageal resting pressure was 20.7 mm Hg (n = 7) compared to 25.9 mm Hg (n = 9) on post-Stretta follow-up ( P = .99). Median FEV1% predicted was 84% (41-97%) before compared to 71% (23-108%) at 1 year after the procedure ( P = .14). Seven patients required fundoplication surgery for continued reflux. All patients were on triple immunosuppression, most commonly prednisone, tacrolimus, and mycophenolate (n = 9). Discussion The Stretta procedure did not provide expected results at our institution after lung transplant surgery. Based on our limited series, we do not recommend routine use of the Stretta procedure for management of GERD in lung transplant patients.

Trans-oral incisionless fundoplication vs stretta, two recognized endoluminal anti-reflux therapies; a systematic review and meta-analysis

Gastro-oesophageal reflux disease (GORD) is common with a prevalence of 10-20% in the Western World. During the last two decades, amongst introduced several endo-luminal techniques, evidence has emerged about the efficacy and safety of two treatment modalities for GORD; 'Stretta' procedure and trans-oral incisionless fundoplication (TIF)' or EsophyX. Author in this study aim to conduct a systematic review of published 'level 1' evidence, to evaluate all evidence on the efficacy of Stretta procedure and TIF (EsophyX) for the management of GORD. A robust literature that included RCT trials only, searched on MEDLINE, EMBASE, and Cochrane library was undertaken from January 2007 until January 2017. The outcomes were normalisation of oesophageal pH values, augmentation of lower oesophageal sphincter pressure (LESP), health-related quality of life (HRQOL) score, and ability to stop or reduce PPI after procedure. For quality assurance purposes, two researchers were involved in the data collection process and its analysis. Author collected data from 9 RCT trials, 3 for Stretta and 6 for EsophyX. From the Stretta trials 101 patients were recruited, 92 patients were analyzed. Of the EsophyX trials, 3 of six papers were from single trial. A total of 296 patients were included and 203 were analysed. The pooled results show both stretta and esophyX significantly improved GORD symptoms. In a meta-analysis of trials, author found that both Stretta and EsophyX significantly improves GERD-HRQL score and enables patients to reduce or stop PPI intake compared with sham/PPI therapy alone. The overall quality of evidence is superior for EsophyX than it is for Stretta.