Specialist commentator comments

Advice

Two specialist commentators recommended that a careful, multi-disciplinary approach should be taken to assess which people could be offered Stretta Therapy. The team should include gastroenterologists, gastrointestinal physiologists and gastrointestinal surgeons. One specialist commentator also stated that patients should have an endoscopy and oesophageal physiological measurement before Stretta Therapy, in the same way that people having surgical treatment are prepared.

One specialist commentator noted that the published evidence does support the use of Stretta Therapy in a limited group of people, but the exclusion criteria rule out most people who are referred for treatment of reflux.

There is still uncertainty about the hospital setting for the Stretta procedure. Three specialist commentators stated that in the NHS, Stretta Therapy would be done in the outpatient endoscopy suite, and another said that the setting for the procedure would be determined by clinical preference and centre infrastructure. One commentator felt that it should only be used in specialist centres, with experienced operators who are certified to use it after proper training and clinical governance approvals in their trusts. Another specialist commentator said that conscious sedation in an outpatient endoscopy suite setting is typically preferred because of the lower cost of sedation compared with general anaesthesia, and patient preference and convenience. But another specialist commentator noted that deep sedation would be used for Stretta Therapy in the UK. One specialist commentator carries out the procedure using total intravenous anaesthesia, with patient recovery in the endoscopy suite and discharge about 3–4 hours after the procedure.

One specialist commentator reflected that Stretta Therapy was not difficult to do, compared with endoscopic resection or peroral endoscopic myotomy, but highlighted that meticulous attention to detail was needed to perform this procedure. This specialist commentator noted that response to Stretta is not immediate, and people are usually reassessed 3 months post-procedure.

One specialist commentator noted controversy around the mode of action of Stretta, particularly because of the lack of physiological evidence. But another specialist commentator felt that the main aims of Stretta Therapy were to treat symptoms, improve quality of life, and reduce reliance on PPI therapy, and that normalising abnormal physiology was not an important measure of success.

One specialist commentator reflected that the complications of Stretta Therapy reported in the literature (that is, pharyngeal pain and retrosternal discomfort) are common to other therapeutic endoscopic procedures on the oesophagus and are typically short-lived. But another specialist commentator noted that there is no data on whether the injury and 'bulking' of the cardiac muscle compromises future surgery if the effect of Stretta does not last.

One specialist commentator was aware of an ongoing (unpublished) single-centre cohort study of Stretta procedures being done in the UK.