eP284 STRETTA: Bridging the Gap Between Pills and Surgery for GERD Relief

Aims Gastroesophageal reflux disease (GERD) is a prevalent condition all over the world. Many patients experience inadequate relief with proton pump inhibitors (PPIs) or are reluctant to use long-term medications due to concerns about adverse effects. Endoscopic anti-reflux therapies provide a minimally invasive alternative for patients who prefer to avoid surgery or continuous medication use. This review aims to evaluate evidence-based recommendations regarding the endoscopic STRETTA procedure for GERD and assess its effectiveness compared to optimal medical and surgical treatments for managing gastroesophageal reflux disease (GORD) symptoms. Methods The review included studies that compared STRETTA with PPI therapy and antireflux surgery (ARS). It analyzed findings from a systematic meta-analysis, prospective studies, and one randomized controlled trial (RCT). Results The evidence suggests that STRETTA may be as effective as medical therapy in alleviating GERD symptoms and could help some patients reduce their reliance on PPIs. However, laparoscopic fundoplication appears to provide superior symptom control, albeit with a higher complication rate. Additional research is necessary to assess the long-term efficacy of STRETTA in comparison to current medical and surgical standards. Conclusions Endoscopic procedures remain a debated option due to lack of high-quality long-term data, and current clinical guidelines lack consensus. This review highlights updated findings on patient selection and outcomes. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) strongly recommends STRETTA as a viable alternative to surgical management for GERD.