GERD issues in pediatrics

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From the dysphagia list:

RF blasts childhood GERD

J Pediatr Surg 2004; 39: 282-286

19 Mar 2004

A novel treatment for adult gastroesophageal reflux disease (GERD) may also

be effective at treating recurring childhood disease.

" Radiofrequency ablation or energy delivery (RF or the Stretta procedure) is

a new method for treating GERD, " Teitelbaum (Mott Children's

Hospital, Ann Arbor, Michigan, USA) and colleagues explain.

Hypothesizing that RF could avoid the complications of adhesion and

recurrence in children requiring repeat surgery for GERD, the team performed

the treatment on six children with recurrent GERD following surgery. The

children were aged an average of 12 years at the time of initial surgery and

18 years at RF.

Surgery took an average of 80 minutes and all patients were discharged as

outpatients. One child experienced self-resolving acute gastric distention

early after RF.

Overall, five of the six children were free of symptoms 3 months after RF

and three had stopped taking antisecretory agents. One of the five patients,

however, underwent further RF 10 months after initial application. The final

patient experienced improvements after RF but remained symptomatic,

requiring fundoplication.

Reporting in the Journal of Pediatric Surgery, the authors note that the

patients experienced an overall drop in average GERD score, from 5.2 to 1.6

points, 6 months after RF.

" Use of RF treatment of the lower esophageal sphincter is a potentially

successful modality to treat recurrent GERD in children, " Teitlebaum et al

conclude.

Nevertheless, they say that " long-term follow-up is required. "

March 2004 . Volume 39 . Number 3

Use of radiofrequency ablation of the lower esophageal sphincter to treat

recurrent gastroesophageal reflux disease

Saleem Islam, D. Geiger

Arnold G. Coran

H. Teitelbaum

Abstract

Purpose Recurrent gastroesophageal reflux disease (GERD) after

gastroesophageal surgery is a troublesome problem. Reoperative surgery often

is complicated by adhesions and recurrence. Radiofrequency ablation or

energy delivery (RF or the Stretta procedure) is a new method for treating

GERD. This study is the first report describing the use of the Stretta

procedure in pediatric patients.

Methods Six patients who underwent previous gastroesophageal surgery

presented with recurrent GERD. Medical records were reviewed and the

severity of reflux graded using a modified scoring system. All underwent RF

and were graded for GERD at 6 months postprocedure.

Results Mean operating time was 80 ± 12 minutes. Mean age at initial

operation was 12 ± 4 years and for the RF, 18.0 ± 3.4 years. All patients

were discharged as outpatients. Early complications occurred in one child

with self-resolving acute gastric distension. Five of 6 patients were

completely asymptomatic at 3 months after the procedure, and 3 stopped anti

secretory agents. One patient was improved but still symptomatic and needed

a redo fundoplication. Another required a repeat application of RF 10 months

after the initial one. Mean GERD score pre-Stretta was 5.2 ± 1.0, which

improved to 1.6 ± 1.9 at 6 months postprocedure (P < .05; paired t test).

Conclusions Use of RF treatment of the lower esophageal sphincter is a

potentially successful modality to treat recurrent GERD in children.

Long-term follow-up is required.