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|Written by Larkshy|
|16 March 2011|
More about stretta procedure. Source: Wikipedia http://en.wikipedia.org/wiki/Stretta_procedure
Stretta procedure is a minimally invasive endoscopic procedure for the treatment of gastroesophageal reflux disease (GERD). A catheter is used to deliver radio frequency energy to the lower esophageal sphincter, muscle and gastric cardia.
The use of radiofrequency energy to augment the LES was pioneered by Utley. The Stretta system, manufactured by the California-based company cofounded by Utley, gained Food and Drug Administration (FDA) approval in 2000.
Stretta is an outpatient procedure performed with the patient under intravenous conscious sedation. The radiofrequency energy is delivered by a four-channel generator while impedance and tissue temperature are monitored to avoid mucosal injury. The device shuts down if the impedance is more than 1000 ohms, the muscle temperature exceeds 100�C, or the mucosal temperature exceeds 50�C. The flexible catheter has a 30-Fr bougie tip and a balloon basket assembly with four 22-gauge, 5.5-mm-long, radially placed electrodes. The catheter also has one channel for suction and another for irrigation with cool water to keep mucosal temperature below 50�C. An upper endoscopy is performed first to identify the gastroesophageal (GE) junction, and a flexible-tip guidewire is passed into the stomach. The endoscope is next withdrawn, and the catheter is passed over the wire, then positioned 1 cm above the Z-line. Balloon inflation places the electrodes into the muscle layer of the lower esophagus, and radiofrequency energy is delivered for 90 s. Witha goal temperature of 85�C, eight lesions are made in a radial manner by rotating the balloon 45�. The catheter is advanced in 0.5-cm increments to create four rings, with the last ring 0.5 cm from the squamocolumnar junction. Two more rings are created in the cardia after the catheter is pulled back at the GE junction.
Endoscopy for a final look completes the procedure. The procedure time is about 40 min. The radiofrequency energy–induced shrinkage of collagen fibrils is a mechanism thought responsible for tightening of the LES and prevention of reflux. Most patients feel maximum benefit over a period of 2 to 6 months when fibrosis, collagen deposition, and wound healing are complete in the smooth muscle layer of the esophagus. Other possible mechanisms include remodeling of the stretch fibers located in the cardia and interruption of the vagal afferent signals to the brainstem that trigger transient LES relaxations.
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