Non-Surgical Stretta Therapy For Recalcitrant GERD Interview with:

Dr. Mark Noar Director of The Heartburn and Reflux Study Center Towson, MD

Dr. Mark Noar

Dr. Mark Noar
Director of The Heartburn and Reflux Study Center
Towson, MD What is the background for this study? What are the main findings?

Response: The background for this study was developed out of a need to know whether the Stretta procedure was effective in both the short and long-term in all forms of reflux. This included standard refluxing patients who had never had surgery but also in the subpopulation of patients who had recurring reflux after having had reflux corrective surgery. The question to be answered was whether the Stretta procedure would be less effective, more effective, or just as effective in the patient who had had prior surgery compared to patients who did not have surgery.

The main findings were that independent of whether a patient had had surgery for the correction of reflux or just had standard reflux without prior surgery, the Stretta procedure was equally effective in all patient subgroups both in the short-term and the long-term. What should readers take away from your report?

Response: One of the most important things that readers should take away from this study is that anyone who has had a prior anti-reflux surgical procedure and then once again begins having reflux that is uncontrollable, can now undergo a stretta procedure, instead of considering other options.

In particular, because of the fear of chronic use of medication to trying control the disease and the mounting number of side effects including increased risk of heart attack, dementia, kidney disease, among others, as well as the high risk of complication and/or death if the surgery is redone, the Stretta procedure represents a safe, complication free, and long-term option for this very large subset of recurring refluxing patients. In fact, the safety and the efficacy of the Stretta procedure in this patient subgroup is so strong, that it should be considered the first line therapy before anything else in this particular patient subset. What recommendations do you have for future research as a result of this study?

Response: As a result of this study, future directions for research would be to determine if other prior anti-reflux procedures could also safely undergo the Stretta procedure and have as successful a result. I have already performed a number of Stretta procedures on patients who have had failed Linx procedures, failed TIF procedures and failed Roux-en-Y procedures, all of which have been very successful following the stretta procedure. However, the number of patients has been quite small in each group.

I believe it would be important to demonstrate that with larger numbers of patients over a long period of time that the Stretta procedure would be the best course of action for failure of any type of reflux procedure surgery. In addition, another very important avenue of research that we are looking at going forward is being able to preselect patients for the best possible initial procedure based upon their pre-treatment studies such as esophageal manometry and anatomical configuration. Be wonderful if we could accurately predict who should first have surgery and then Stretta or vice versa. We are close to being able to do this, but more study is required. This leads us closer and closer towards the approach of using personalized medicine in the treatment of GERD. Is there anything else you would like to add?

Response: I think it is interesting to note that the long-term efficacy as well as safety of the Stretta procedure is so strong in terms of reported data, and that the flexibility of the procedure to be performed when other procedures have failed also in a safe and efficacious manner, such that suggests that the Stretta procedure is the least harmful and most effective option for those who failed any prior reflux treatment. So not only is the Stretta procedure the best salvage procedure for other failed technology, but is also the best first effort procedure. With regard to disclosures, I do serve as a consultant, as well as training and lecturing for Mederi therapeutics. Thank you for your contribution to the community.


Surg Endosc. 2016 Dec 30. doi: 10.1007/s00464-016-5296-9. [Epub ahead of print]

Radiofrequency energy delivery to the lower esophageal sphincter improves gastroesophageal reflux patient-reported outcomes in failed laparoscopic Nissen fundoplication cohort.

Noar M1, Squires P2, Khan S3.

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on January 24, 2017 by Marie Benz MD FAAD

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