Viswanath Yirupaiahgari Krishnaiah Setty, Mbarushimana Simon, Ammar Ahmed, Madhusudanan Gowri Pillai, Kourounis George, Reddy Anil
Department of Upper GI Surgery, James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Marton Road, Middlesbrough, Cleveland, TS4 3BW, UK.
Department of Colorectal Surgery, James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Lecturer at Newcastle University, Middlesbrough, UK.
Surg Endosc. 2025 May 27. doi: 10.1007/s00464-025-11781-7.
Gastroesophageal reflux disease (GERD) is a common chronic condition affecting millions all over the world. It occurs due to the reflux of gastric acid into the oesophagus. Endoscopic therapies like STRETTA offer minimally invasive options to manage GERD. This study aims to evaluate the role of STRETTA in patients with recurrent symptoms after structurally intact hiatus hernia repair with anti-reflux surgery (ARS) and in patients who had an initially successful STRETTA.
A retrospective review was conducted on patients who underwent STRETTA from 2014 to 2024 at a tertiary centre to identify patients whose STRETTA therapy followed either a primary ARS (OP to STR) or primary STRETTA (STR to STR). Patients' outcomes were assessed before and after the STRETTA procedure using validated RSI (Reflux symptom index), and GERD HRQL (Gastro Esophageal Reflux Disease Health-Related Quality of Life) quality of life (QoL) questionnaires. The use of anti-secretory medications was analysed using Chi-Square (X) test.
19 eligible patients were studied under 2 cohorts: 13 underwent STRETTA following a primary ARS (OP to STR) and 6 had a repeat STRETTA following a primary successful STRETTA (STR to STR). The median time from ARS to STRETTA was 8.7 years compared with 5.5 years in the STR to STR group, p = 0.180. The median follow-up in the ARS to STR group was significantly longer at 5.7 years compared to 0.8 years in the STR to STR, p = 0.008. The median age was 66.0 years in ARS to STRETTA group and 54.5 years in the STR to STR cohort. The OP to STR cohort saw a significant reduction in the RSI (Wilcoxon V = 84.5, p = 0.007) and improvement in QoL (Wilcoxon V = 66, p = 0.004). The STR to STR cohort did not show a statistically significant improvement in either RSI (Wilcoxon V = 15, p = 0.058) or QoL scores (Wilcoxon V = 19, p = 0.093). No statistically significant difference was noted in the usage of PPIs in either cohort.
This retrospective, small sample and single-centre study opens the debate about the role of endoscopic radiofrequency STRETTA therapy in selected recurrent GERD patients following successful primary ARS. Furthermore, though our limited data showed no statistically significant benefit in RSI and GERD HRQL for the STR to STR cohort, this is a compelling topic which begs for larger robust studies.
胃食管反流病（GERD）是一种常见的慢性疾病，影响着全球数百万人。它是由于胃酸反流至食管而发生的。像STRETTA这样的内镜治疗为GERD的管理提供了微创选择。本研究旨在评估STRETTA在抗反流手术（ARS）修复结构完整的食管裂孔疝后出现复发症状的患者以及最初STRETTA治疗成功的患者中的作用。
对2014年至2024年在一家三级中心接受STRETTA治疗的患者进行回顾性研究，以确定其STRETTA治疗是在初次ARS（OP至STR）之后还是初次STRETTA（STR至STR）之后。使用经过验证的反流症状指数（RSI）和胃食管反流病健康相关生活质量（GERD HRQL）生活质量（QoL）问卷在STRETTA手术前后评估患者的结局。使用卡方（X）检验分析抗分泌药物的使用情况。
在2个队列中研究了19例符合条件的患者：13例在初次ARS后接受了STRETTA（OP至STR），6例在初次STRETTA成功后进行了重复STRETTA（STR至STR）。从ARS到STRETTA的中位时间为8.7年，而STR至STR组为5.5年，p = 0.180。ARS至STR组的中位随访时间明显更长，为5.7年，而STR至STR组为0.8年，p = 0.008。ARS至STRETTA组的中位年龄为66.0岁，STR至STR队列的中位年龄为54.5岁。OP至STR队列的RSI显著降低（Wilcoxon V = 84.5，p = 0.007），生活质量得到改善（Wilcoxon V = 66，p = 0.004）。STR至STR队列在RSI（Wilcoxon V = 15，p = 0.058）或生活质量评分（Wilcoxon V = 19，p = 0.093）方面均未显示出统计学上的显著改善。两个队列中质子泵抑制剂（PPI）的使用均未发现统计学上的显著差异。
这项回顾性、小样本和单中心研究引发了关于内镜射频STRETTA治疗在初次ARS成功后选定的复发性GERD患者中的作用的争论。此外，尽管我们有限的数据显示STR至STR队列在RSI和GERD HRQL方面没有统计学上的显著益处，但这是一个引人注目的话题，需要进行更大规模的有力研究。
