Talk:Stretta procedure

From WikiProjectMed
Jump to navigation Jump to search

Removal of the 2015 review article

Not sure why this was removed "A 2015 systematic review and meta-analysis in response to the systematic review (no meta-analysis) conducted by SAGES did not support the claims that Stretta was an effective treatment for GERD.[1]"

Doc James (talk · contribs · email) 20:24, 15 November 2015 (UTC)[reply]

It's in there now, right? I'm not sure why it was removed either, except there appears to be some COI editing going on. Sundayclose (talk) 18:08, 17 November 2015 (UTC)[reply]
Yes. Have restored it. Hopefully it will stick now. Doc James (talk · contribs · email) 00:41, 18 November 2015 (UTC)[reply]

You should read very closely. The meta-analysis says Stretta shows not more oder better effects than the compared therapy method (eg. PPI) . Which means on the other hand it helps just as well as PPIs for example. You should consider this in the article. — Preceding unsigned comment added by 79.212.239.215 (talk) 09:22, 15 January 2016 (UTC)[reply]

Unsourced 1

The following is unsourced and per WP:VERIFY I am moving it here til it can be sourced according to WP:MEDRS

Procedure

The Stretta device design and function specifically allows for treatment of the muscularis propria. Patients typically receive conscious sedation with a combination of midazolam and fentanyl. First, a diagnostic upper endoscopy is performed to locate the gastroesophageal junction. Upon endoscope removal, a wire-guided flexible RF delivery catheter (a balloon-basket assembly with four treatment elements positioned radially around the balloon) is passed transorally then positioned within the gastroesophageal junction. After appropriate balloon inflation (<2.5 psi), the treatment elements are deployed 3–4 mm into the LES muscle, where energy is delivered in a series of thermal treatments at four levels in two positions (distal esophagus) and at two levels in three positions (gastric cardia). The monitoring of temperature and impedance at each treatment element ensured safe and precise RF delivery. As RF energy is applied during the procedure, chilled water is irrigated from the catheter to the esophageal mucosa to prevent unintended treatment of that tissue. After completion of the procedure and catheter removal, the endoscopy is repeated to verify that there have been no complications. All pre-Stretta medication is maintained for 6–8 weeks after the procedure to maintain baseline and allow time for complete procedural effect, and prevent potential complications.

- Jytdog (talk) 17:05, 25 February 2016 (UTC)[reply]

Unsourced/inappropriately sourced 2

The following has unsourced content, and content sourced in ways that fail MEDRS. Am putting it here til it can be appropriately sourced, per VERIFY.

Mechanism of action

The Stretta device design and function specifically allows for treatment of the muscularis propria only, and neither the mucosa or submucosa. After proper positioning, the thermocouple-controlled device monitors impedance, temperature, and regulates energy output. Typical impedance values are 70-200 ohms on a scale of 1-1000, indicative of placement in dense saturated muscle tissue. Higher impedance values cause generator shutoff, preventing unintended treatment of mucosa or submucosa. The device maintains muscularis temperatures at 65-85 °C levels for short duration, well below treatment time and temperature to induce fibrosis or necrosis. No publication or other evidence exists demonstrating fibrosis or restriction. Recent works demonstrate that low power/low temperature radiofrequency stimulation results in muscle fiber bundle proliferation and increased muscle cell volume within each bundle, causing sphincter lengthening, thickening, and increased physiological barrier function.[2] The effect of these physiological changes is further borne out by studies that have confirmed increased LES tone,[3][4][5] reduced esophageal acid exposure with reported normalization of pH,[3][4][6][7] increased gastric yield pressure,[8] and improvements in gastric emptying[9] and gastric motility.[10] Importantly, what has not been demonstrated is denervation or desensitization of the esophagus, with a number of studies refuting this conjecture[5][6][7][9] There are no histopathological studies demonstrating neurolysis or desensitization within the esophagus after Stretta but instead there is supporting evidence of effects based on physiological data.

References

  1. ^ Lipka, S; Kumar, A; Richter, JE (June 2015). "No evidence for efficacy of radiofrequency ablation for treatment of gastroesophageal reflux disease: a systematic review and meta-analysis". Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 13 (6): 1058-67.e1. PMID 25459556.
  2. ^ Herman R, Wojtysiak D, Rys J, Nowakowski M, Schwartz T, Murawski M; et al. (2013). "Interstitial Cells of Cajal (ICCs) and Smooth Muscle Actin (SMA) Activity After Non-Ablative Radiofrequency Energy Application to the Internal Anal Sphincter (IAS): An Animal Study". Gastroenterology. 144 (5): S372. doi:10.1016/s0016-5085(13)61371-2.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  3. ^ a b Cite error: The named reference Perry2012 was invoked but never defined (see the help page).
  4. ^ a b Tam WC, Schoeman MN, Zhang Q, Dent J, Rigda R, Utley D; et al. (2003). "Delivery of radiofrequency energy to the lower oesophageal sphincter and gastric cardia inhibits transient lower oesophageal sphincter relaxations and gastro-oesophageal reflux in patients with reflux disease". Gut. 52 (4): 479–85. doi:10.1136/gut.52.4.479.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  5. ^ a b Arts J, Sifrim D, Rutgeerts P, Lerut A, Janssens J, Tack J (2007). "Influence of radiofrequency energy delivery at the gastroesophageal junction (the Stretta procedure) on symptoms, acid exposure, and esophageal sensitivity to acid perfusion in gastroesophagal reflux disease". Digestive diseases and sciences. 52 (9): 2170–7. doi:10.1007/s10620-006-9695-y.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  6. ^ a b Triadafilopoulos G (2004). "Changes in GERD symptom scores correlate with improvement in esophageal acid exposure after the Stretta procedure". Surgical endoscopy. 18 (7): 1038–44. doi:10.1007/s00464-003-8243-5.
  7. ^ a b Richards WO, Houston HL, Torquati A, Khaitan L, Holzman MD, Sharp KW (2003). "Paradigm shift in the management of gastroesophageal reflux disease". Annals of Surgery. 237 (5): 638–47. doi:10.1097/01.sla.0000064358.25509.36.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  8. ^ Utley DS, Kim M, Vierra MA, Triadafilopoulos G (2000). "Augmentation of lower esophageal sphincter pressure and gastric yield pressure after radiofrequency energy delivery to the gastroesophageal junction: a porcine model". Gastrointest Endosc. 52 (1): 81–86. doi:10.1067/mge.2000.105981.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  9. ^ a b Noar MD, Noar E (2008). "Gastroparesis associated with gastroesophageal reflux disease and corresponding reflux symptoms may be corrected by radiofrequency ablation of the cardia and esophagogastric junction". Surgical endoscopy. 22 (11): 2440–4. doi:10.1007/s00464-008-9873-4.
  10. ^ Noar MD, Xu L, Koch KL (2003). "Effect of radiofrequency ablation on gastric dysrhythmias in patients with gastroesophageal reflux disease (GERD) and functional dyspepsia". Gastroenterology. 124 (4): A98. doi:10.1016/s0016-5085(03)80481-x.{{cite journal}}: CS1 maint: multiple names: authors list (link)

- Jytdog (talk) 17:06, 25 February 2016 (UTC)[reply]

Retrieved from "https://mdwiki.org/wiki/Talk:Stretta_procedure"