Reflux Surgery Part II: EndoCinch and Stretta
There have been many changes in the surgical approach to treating chronic gastroesophageal reflux disease even in the brief time my children have been dealing with it. Some of the newest procedures being studied use endoscopic techniques to deal with reflux issues. This blog is Part II of my series on surgical options. In it I will discuss two of the newest procedures, the EndoCinch and the Stretta System.
EndoCinch: EndoCinch also known as the Endoluminal Gastroplication Procedure alters the LES by forming pleats in the sphincter with the use of stitches which are pulled together. The benefits to a procedure like this one is that it can be done without incisions. The doctor goes through the patient's mouth with the endoscope to reach the LES (1). Reviews are mixed with regard to the success of the EndoCinch procedure. One study done in children showed improvement as well as a decrease in the need for anti reflux meds (2).
However several other studies have mixed reviews. They have shown that though the EndoCinch procedure may reduce the need for anti reflux meds it still needs further study before it can be recommended. Experts note that the EndoCinch did not normalize acid reflux and has no long term clinical data to substantiate claims. There are also concerns regarding the long term effects of this surgery (3,4).
Stretta System: The Stretta system consists of placing a catheter into the mouth and down to the LES. Once placed the balloon is inflated to the size of the individual's LES and radio waves are passed into the tissue. The radio waves are thought to provide a tightening effect to the LES and thus prevent acid from backing up into the esophagus (5).
The preliminary data appears to be positive with regard to the efficacy of the Stretta system. Large studies have shown that it can reduce the use of medication, decrease symptoms and improve the quality of life scores for some patients (4). Unfortunately, for people with severe GERD, the reviews are not as positive. They indicated that patients with less severe preoperative symptoms were more likely to respond to this treatment (6).
Tune in next month for Part III of the series which will discuss Transoral Incisionless Fundoplication and the SRS endoscopic stapling system.