Endoscopic therapy of gastroesophageal reflux disease using radiofrequency energy (Stretta procedure) – treatment of the first patients in the Czech Republic

Gastroesophageal reflux disease (GERD) is the most common disease of the gastrointestinal tract, affecting approximately a quarter of the European population with an increasing incidence. Some patients with GERD do not get full relief with conservative approach with proton pump inhibitors (PPI), while surgical solution is burdened with a significant percentage of complications and its effectiveness decreases over time. Endoscopic therapy of GERD currently includes five different methods, none of which have, to the knowledge of the authors, been more widely available and performed in the Czech Republic. The methods of electrical oesophageal stimulation, endoscopic fundoplication and Stretta have the potential to be used in practice. The latter method consists in the application of a low-frequency radiofrequency energy to the oesophagogastric junction (EGJ). According to the data published so far, it is probably a less effective alternative to laparoscopic fundoplication for patients with hiatal hernia ≤ 2 cm and failed conservative treatment, but its favourable safety profile, absence of EGJ anatomy alteration, repeatability and long-time effect in most patients are its undeniable advantages. On the other hand, the need to select suitable patients for the procedure and higher costs are among its disadvantages. Despite its limitations, Stretta offers an alternative option in the future for selected patients who would like to avoid the risks associated with long-term PPIs and are concerned about the risks of laparoscopic fundoplication. Keywords gastroesophageal reflux disease, endoscopic therapy, radiofrequency energy, Stretta