Obstract　To investigate the short-term clinical outcome of Stretta radiofrequency for patients with refractory nonerosive reflux disease (NERD).

Fifty patients with refractory NERD underwent Stretta procedure were enrolled. They were followed-up for six months after Stretta procedure. The symptom control, quality of life, satisfaction rate, lower esophageal sphincter (LES) pressure, 24-hour pH and proton pump inhibitor (PPI) usage were evaluated. The complications were assessed. The outcomes of the 6-months follow-up results were analyzed and compared with the baseline data.

Stretta procedure was succeed in all 50 patients. No severe adverse events or complications occurred. Forty-eight patients finished the 6-month follow-up, Stretta was effective in both reducing total symptom scores (from 17.0±5.3 to 6.4±3.9, t=12.332, P=0.000) and improving quality of life scores (from 546.6±149.8 to 607.4±143.5, t=-3.479, P=0.002). Forty-five patients (94%) were satisfied with the intervention. LES pressure increased significantly (from 9.9±4.3 mmHg to 14.4±4.6 mmHg, t=-5.541, P=0.000). Regarding 24-hour pH monitoring, reflux episodes (62 vs. 30, Z=-5.565, P=0.000), pathological acid exposure (8.3% vs. 4.4%, Z=-5.583, P=0.000) and DeMeester score (28.7 vs.13.0, Z=-5.733, P=0.000) were improved significantly compared to the baseline (P=0.000). 62% patients with mild pathological acid reflux and 22% with moderate pathological acid reflux achieved normal esophageal acid exposure. At the 6-month follow-up, complete PPI cessation was achieved in 42 patients (88%), 5 patients (10%) took PPI on-demand while 1 patient (2%) took PPI as much as before the Stretta procedure. Two patients who cannot stop PPI underwent Laparoscopic Nissen fundoplication and achieved symptom control and PPI cessation, too.

The Stretta procedure was safe and effective in the short term for the management of NERD. It can improve LES pressure as well as 24-hour pH metrics, especially for mild reflux patients, and achieved improvement of symptom control and PPI cessation in the short term follow up. Fundoplication is feasible and effective after failed Stretta procedure.