Research Article
Volume 7 Issue 10 - 2020
A Novel Endoscopic Assessment Score which Predicts Long Term Outcome Following Stretta; Early Results
YKS Viswanath* and Edward J Nevins
Department of Upper GI Surgery, James Cook University Hospital, South Tees NHS Foundation Trust, Middlesbrough, Cleveland, United Kingdom
*Corresponding Author: YKS Viswanath, Professor of Surgery, Consultant Surgeon (Upper GI and Laparoscopic), Honorary Professor Teesside University, MCh Programme Director, South Tees Hospitals NHS Foundation Trust, James Cook University Hospital, Middlesbrough, Cleveland, United Kingdom.
Received: August 10, 2020; Published: September 10, 2020


Background: Endoscopic anti-reflux radio-frequency therapy (STRETTA) is a NICE approved treatment for gastro-esophageal reflux disease (GERD). To obviate poor outcomes, there is a need for clinicians to select suitable patients who are likely to benefit. There are no published endoscopic scores, for use before endoscopic anti-reflux therapy, which predicts an outcome. This study aims to produce an endoscopic score which predicts good outcome following STRETTA for GERD.

Materials and Methods: All patients undergoing STRETTA therapy between July 2017 and January 2018 were scored at the time of their pre-STRETTA endoscopy by an expert endoscopist. The following criteria make up the score: Crural insufficiency; z line displacement; prolapse of the stomach; preservation of angle of His; depth of the fundus from GOJ on retroversion; erosive esophagitis. Patients were then independently scored by a specialist Upper GI trainee to ensure reproducibility. GERD Health-Related Quality of Life Questionnaires were obtained before STRETTA, and again at 12 months. Statistical analysis was performed comparing pre-STRETTA endoscopic scores and patients reported outcomes.

Results: A total of 19 patients were analysed, 15 patients reported improvement in the symptom scores and 12 of then expressed full satisfaction at 12 months. There was no significant difference between scores produced by both endoscopists (> p.0.05), confirming reproducibility. No single endoscopic criteria were predictive of good outcome (p > 0.05). However, group A (completely satisfied) patients had significantly lower total scores than group B (improved and non-improved) patients, 3.42 vs 6.43 (p = 0.012). ROC curve analysis demonstrates a score less than or equal to 5 is likely to produce a good outcome (92% sensitivity, 71% specificity).

Conclusion: This is a novel endoscopic assessment score which may predict a successful outcome in patients undergoing STRETTA for GERD. This requires prospective validation in a new cohort of patients; this is ongoing.

Keywords: STRETTA; Outcomes; Prediction of the Outcome; Endoscopic Management; GERD; Endoscopic Evaluation


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Citation: YKS Viswanath and Edward J Nevins. “A Novel Endoscopic Assessment Score which Predicts Long Term Outcome Following Stretta; Early Results”. EC Gastroenterology and Digestive System 7.10 (2020): 07-12.

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