Endoscopic Acid Reflux Treatment: Stretta

Endoscopic Acid Reflux Treatment: Stretta

Sandy from Houston sent us this question: “I have had two Strettas procedures in the past, which were very successful in stopping my LPR symptoms; however, the procedures were undone by a pregnancy and some medications that I must take. I’m looking for a more permanent fix. My LES has been shown to be completely patent on endoscopy, I reflux into my throat on a Barium Swallow, and I’ve had evidence of reflux found on biopsies of my esophagus. All these issues improved after having Stretta. Would I be a candidate for Nissen fundoplication surgery at your clinic? Thank you.”

Dear Sandy,

Stretta, an incisionless procedure, is not a reliable treatment for acid reflux disease, including LPR. I am not surprised your LPR recurred following two Stretta treatments. At Houston Heartburn and Reflux Center, Stretta is not offered. Rather, we recommend laparoscopic Nissen fundoplication and hiatal hernia repair for both GERD and LPR.

In your question, you present strong evidence for acid reflux. Contrast reflux on barium swallow, inflammation of distal esophagus on biopsies, and patient lower esophageal sphincter due to hiatal hernia are clear indications for Nissen fundoplication to stop reflux.

We recommend esophageal manometry prior to Nissen fundoplication and hiatal hernia repair. Esophageal manometry evaluates esophageal contraction. Most acid reflux patient qualify for Nissen fundoplication. However, in the case of very weak esophageal contractions, a partial (Toupet) fundoplication is preferred over a 360 degree or Nissen fundoplication to avoid post-operative dysphagia (difficulty swallowing).