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Performing the Stretta Procedure for GERD New Minimally Invasive Treatment of Gastroesophageal Reflux Disease

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Performing the Stretta Procedure for GERD New Minimally Invasive Treatment of Gastroesophageal Reflux Disease WINTER/ SPRING 2002 Number 14 PNews UpdateO from the STDepartment of SurgeryOp UNIVERSITY. HOSPITAL. AND. HEALTH. SCIENCES. CENTER. AT. STONY. BROOK Performing the Stretta Procedure for GERD New Minimally Invasive Treatment Of Gastroesophageal Reflux Disease he Center for Minimally Invasive Surgery is pleased to announce the introduction of a new minimally invasive technique for the treatment Tof gastroesophageal reflux disease (GERD). Called the Stretta procedure, this newly developed outpatient endoscopic procedure takes about one hour to perform, and provides considerable benefits to patients. Stony Brook University Hospital is the only health facility in Suffolk that offers the Stretta procedure, the use of which further demonstrates our commitment to providing truly state-of-the-art patient care. Arif Ahmad, MBBS, assistant professor of surgery and director of the Center for Minimally Invasive Surgery, and Louis T. Merriam, MD, assistant Initial experience with the Stretta professor of surgery, have acquired the training necessary to perform the procedure for the treatment of procedure. With special expertise in minimally invasive “videoscopic” gastroesophageal reflux disease surgery, they both have a long-standing interest and proficiency in the BACKGROUND: The Stretta device (Curon Medical, surgical correction of GERD. Sunnyvale, CA) is a balloon-tipped four-needle catheter that delivers radiofrequency (RF) en- Because there is no hospital stay involved with the Stretta ergy to the smooth muscle of the gastroesoph- procedure, patients undergoing the procedure are able to ageal junction. It can be used for the endoscopic treatment of gastroesophageal participate in normal activities the following day. reflux disease (GERD). Describing the procedure’s benefits, Dr. Ahmad says: “No hospital stay PATIENTS AND METHODS: Data prospectively col- lected on the first 25 consecutive patients un- is required and typically patients may return to normal activities the dergoing the Stretta procedure at Vanderbilt following day. Moreover, most patients are able to discontinue acid-reducing University Medical Center between August GERD medications in a month.” 2000 and March 2001 are reported. Patient The procedure itself is performed with a flexible, disposable catheter evaluation included esophageal manometry, connected to a radiofrequency (RF) generator. With the patient under ambulatory 24-hour pH testing, a standard GERD-specific quality-of-life survey (QOLRAD), conscious sedation, the surgeon delivers controlled RF energy to the lower a general quality-of-life survey (SF12), and en- esophageal sphincter (LES) muscle and gastric cardia to create thermal doscopy. lesions. As the lesions heal, the barrier function of the LES is enhanced, Stretta surgery was performed following a standardized protocol. Thermocouple-con- reducing the frequency of reflux events. trolled RF energy was delivered to the lower Early clinical studies appearing in the medical literature demonstrate esophageal sphincter (LES) after endoscopic that the Stretta procedure is a promising new treatment of GERD, which location of the z-line. Patients were followed affects 1 in 14 adults in the United States today. up 3 months after endoscopic treatment. Results are presented as mean ±SEM. For consultations/appointments with Dr. Ahmad and Dr. Merriam, DEPARTMENT OF SURGERY • UNIVERSITY HOSPITAL AND HEALTH SCIENCES CENTER • STONY BROOK UNIVERSITY (Continued on Page 3) — 1 — please call the Center for Minimally Invasive Surgery at (631) 444-4545. AMBULATORY SURGERY CENTER NOW OPEN AT STONY BROOK pened in early March, the new Ambulatory Surgery Center at Stony Brook Ois located next to University Hospital. The spacious, state-of-the-art facility (32,000 square feet) is designed to create a comfortable, stress-free outpatient surgery experience for both adult and pediatric patients. The Center has six operating rooms and two minor procedure rooms— all with the latest equipment and monitors. Consistent with the latest concepts in ambulatory surgery, the recovery area is divided into two stages. The first-stage room serves as a conventional re- covery area and is set up for those patients requiring more frequent observation. But many patients go directly to a sec- ond-stage room where they can be fed, en- joy their families, and relax before going home—thanks to new short-acting anes- thetics, combined with minimally invasive surgical techniques, that are allowing more and more patients safely to bypass the con- ventional recovery process with minimal, if any, pain or nausea. The Center’s planners paid particular attention to the needs of children and their families. There are pediatric play areas with specially designed furniture for chil- dren, as part of our effort to make their ex- perience as pleasant as possible. Easy accessibility for both patients and surgeons is a high priority of the Center. Parking is easy, plentiful, and free of charge. The Center also houses the preoperative testing area for inpatient surgery. POST-OP is published by the This area allows patients to have their inpatient preoperative lab tests, EKGs, Department of Surgery University Hospital and chest x-rays, and history/physicals all done in one easy visit. Health Sciences Center Stony Brook University For more information, please visit the Ambulatory Surgery Center’s website at Stony Brook, New York www.uhmc.sunysb.edu/AMB Editor-in-Chief John J. Ricotta, MD The Lung Cancer Evaluation Center, established by the Cancer Institute of Long Island at Stony Brook, Writer/Editor provides comprehensive care for patients with known Jonathan Cohen, PhD or suspected lung cancer, as well as those individuals Contributing Editor at special risk of developing lung cancer. Andrew E. Toga, FACHE lung Advisory Board Patients who have x-ray abnormalities that might Collin E.M. Brathwaite, MD represent lung cancer, or patients who have a known Alexander B. Dagum, MD diagnosis of cancer, can undergo evaluation by all of Peter J. Garlick, PhD the physicians involved in the diagnosis and treatment Arnold E. Katz, MD cancer Irvin B. Krukenkamp, MD of lung cancer. Cedric J. Priebe, Jr., MD evaluationAt the conclusion of the initial visit, each patient’s case Harry S. Soroff, MD has been reviewed by the Center’s multidisciplinary All correspondence should be sent to: team of physicians, and a plan for diagnosis or Dr. Jonathan Cohen treatment is then formulated based on their combined Writer/Editor, POST-OP center Department of Surgery expert opinion. Health Sciences Center T19 Stony Brook, NY 11794-8191, USA For more information, please call the program coordinator, Eileen Vilim, RN, at (631) 444-2981. — 2 — DEPARTMENT OF SURGERY • UNIVERSITY HOSPITAL AND HEALTH SCIENCES CENTER • STONY BROOK UNIVERSITY Performing the Stretta PERFORMING HISTORIC Procedure for GERD (Continued from Page 1) HEART OPERATION RESULTS: Prior to treatment, patients had a Saving Patient’s Life With mean DeMeester score of 31.0 ± 11.4, Five Simultaneous Procedures an LES pressure of 24 ± 2 mm Hg, and normal esophageal peristalsis. Of the 25 Including New Technique outpatient procedures, 19 were done un- der conscious sedation and 6 under gen- n December, the Division of Cardiothoracic Surgery made history by eral anesthesia. There was a small performing a series of five heart procedures on a single patient during a learning curve (76 8 min for the first I ± single operation, giving the patient a new and unexpected lease on life. three procedures; 50 ± 2 min for the subsequent 22). This operation marked the first time so many cardiac procedures were successfully performed at once. The mild to moderate pain during the A novel microwave technique, moreover, was first 24 postoperative hours was con- trolled with over-the-counter medication. used to treat the patient’s abnormal heart rhythm. Two complications were noted: one pa- The history-making heart operation, which took tient presented with ulcerative esophagi- three and a half hours to complete, was performed by tis and gastroparesis 10 days after the Irvin B. Krukenkamp, MD, professor of surgery and Stretta treatment, and one patient devel- physiology/biophysics and chief of cardiothoracic sur- oped pancreatitis on postoperative day 27, which was probably unrelated to the gery, and Adam E. Saltman, MD, PhD, assistant pro- Stretta procedure. fessor of surgery and physiology/biophysics, along with eight other members of Stony Brook’s cardiac Eight of the thirteen patients (62%) avail- Dr. Irvin B. team. able for 3-month follow-up were off all Krukenkamp antisecretory medication. The other five The patient, a 69-year-old man from Blue Point, patients were still taking medications but NY, was released from cardiac rehabilitation in early had been able to reduce the amount con- January, after having successfully completed his for- siderably. The average daily dose of pro- mal recuperation post-surgery. Prior to the operation, ton pump inhibitors was 43.0 ± 5.0 mg/ he had a life expectancy of about six months. preoperatively and 6.4 ± 2.2 mg/3 months postoperatively (P < 0.001). Now, according to Dr. Krukenkamp, the father of Other classes of GERD treatment such as three and grandfather of four can expect to live well metoclopramide had been completely into his eighties. abandoned. The entire operation comprised a single-vessel In all patients, QOLRAD scores improved bypass procedure to relieve a blocked coronary artery; (3.5 ± 0.4 to 5.5 ± 0.5; P < 0.001) as did replacement of a damaged aortic valve; patching the SF12 physical (23.7 ± 3.0 to 31.0 ± 3.4; Dr. Adam E. hole between the heart’s upper chambers; repairing a Saltman P < 0.008) and mental (40.5 ± 2.9 to leaky tricuspid valve to restore proper blood flow in 47.7 ± 3.2, P < 0.017) scores. All pa- the right side of the heart and relieve the heart failure and potential liver tients would undergo a Stretta procedure again except one 78-year-old man with failure; and curing the abnormal heart rhythm with the new microwave progressive Alzheimer’s disease.
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