Treating reflux esophagitis using an endoscope Stretta Procedure

Reflux esophagitis is accompanied by a wide range of symptoms including a foreign body sensation in the throat, dry cough, burning sensation in the chest, bad breath, indigestion and excessive belching, which can greatly deteriorate the quality of life. This condition, which could only be treated by surgery in the past, can now be treated using an endoscope. Rea

Growing prevalence of esophagitis

Reflux esophagitis occurs when the muscle acting as a barrier between the esophagus and the stomach undergo degenerative changes or when the regenerative power of cells is weakened. Although this condition occurred more frequently in the West, the prevalence in Korea has surged in recent years, due to westernized diet and aging of the population. If it is not treated at the right time, esophagitis will develop into a chronic condition, and in the worst case scenario, it will lead to esophageal cancer. So, proper and timely treatment is essential. Symptoms can be alleviated with drugs that inhibit the secretion of gastric acid, but the root cause can only be eliminated by surgery due to the fact that the condition recurs quite easily and symptoms can continue despite drug therapy.

Treating reflux esophagitis using an endoscope

Stretta is a procedure where a tube is inserted through the mouth to supply the degenerated muscle or cells with radiofrequency (RF) energy at low frequencies. This helps strengthen the muscle and prevent the reflux of food, thereby ameliorating the symptoms associated with reflux esophagitis. The procedure is quite similar to endoscopy, so it is recommended to patients who do not want to undergo surgery, and it requires a short downtime quick recovery. The Stretta procedure has already been performed for years outside Korea, and with proven effectiveness, it has been recognized as one of the treatment methods for reflux esophagitis by the American Gastroenterological Association (AGA).

CHA Bundang Medical Center, the one and only hospital in Korea equipped with the means to surgically and non-surgically treat reflux esophagitis

By adopting the Stretta procedure, CHA Bundang Medical Center became the one and only hospital in Korea to be equipped with the means to surgically and non-surgically treat reflux esophagitis. The team (Professor Won-jin Go and Ga-won Song) headed by Professor Ju-young Jo has been treating patients with intractable reflux esophagitis after becoming the first in Korea to develop an anti-reflux endoscopic surgery method last year. They also became Korea?s first to adopt a diagnostic tool called EndoFLIP, which enables real-time measurements of the pressure in the lower part of the esophagus, and this has helped increase the accuracy of diagnosis and treatment for reflux esophagitis patients. Armed with such diverse therapeutic methods and technologies, CHA Bundang Medical Center has been boosting satisfaction among its patients with reflux esophagitis.

A new alternative to reflux esophagitis treatment

Professor Jo, the Head of the Gastroenterology in the Department of Internal Medicine at CHA Bundang Medical Center, who performs the Stretta procedure, explains, "Development of therapeutic methods using new technology and equipment play a major role in overcoming various diseases that have long been considered "intractable.? The Stretta procedure will also become a new alternative for patients suffering from reflux esophagitis." With the development of new endoscopic treatment methods, Professor Jo has been honored with awards on educational videos from AGA every year since 2006. He brought the Per-oral Endoscopic Esophagomyotomy (POEM) procedure, an endoscopic treatment measure for achalasia to Korea for the first time in 2011 and successfully performed the procedure on more than 130 patients with intractable esophageal diseases.

A high-resolution esophageal manometry for diagnosis of esophagogastric junction (EGJ) outflow obstruction

The team (Professor Ju-young Jo and Won-jin Go) headed by Professor Ju-young Jo analyzed the results of in-depth examinations performed on 424 patients in relation to intractable gastroesophageal reflux disease (GERD) from March 2015 to January 2017. The results showed that 15.8% of the patients under analysis were suffering from esophagogastric junction outflow obstruction (EGJOO). EGJOO is a disease characterized by failed or incomplete opening of the EGJ, which is the point where food passes from the esophagus to the stomach. Its symptoms are similar to those of GERD, caused by looseness of the EGJ, but the causes of the disease and treatment methods are different. In order to accurately diagnose EGJOO, there is a need to perform high-resolution manometry (HRM). Currently in Korea, there are around 2.8 million patients who are registered as having a GERD. GERD patients, who have been suffering from chronic heartburns, foreign body sensation in the throat and other symptoms, despite receiving drug therapy, are recommended to receive a more in-depth examination so that they can receive proper treatment based on an accurate diagnosis.

Stretta Procedure Mimetic Diagram

• Place the balloon into the esophagus and expand it. The procedure is comprised of 6 steps in total, of which 4 steps are performed in the esophagus and 2 steps in the stomach.
• After securing the necessary space with the balloon, secure the line in place around the lesion before delivering electric stimulations and thermal energy.
• When you take a look at the esophagogastric junction (EGJ) after the procedure, you will see that the condition has improved significantly. The Stretta procedure involves delivering thermal energy to the muscles located at the EGJ using a special device to increase muscle strength and prevent the reflux of gastric acid, and its safety has been proven internationally.

An endoscopic image of a patient who has undergone the Stretta procedure

• Before the Stretta procedure: EGJ has become enlarged.
• Insert Stretta into the esophagus.
• Immediately after the Stretta procedure: There are traces of treatment at the EGJ.
• 2 months after the Stretta procedure: The EGJ has become narrower.

The world's most prestigious medical practice with a wealth of clinical experience and high success rates in treatment

Professor Cho, Joo Young

Director of the Department of Internal Medicine, Section of Gastroenterology, CHA Bundang Medical Center, CHA University
031-780-5641