Delivery of Radiofrequency Energy (Stretta Procedure) for Treating Laryngopharyngeal Reflux Symptoms in Reflux Disease: A Systematic Review.

OBJECTIVE: This review investigated the effectiveness of the Stretta procedure, ie, radiofrequency delivery to the gastroesophageal junction, on laryngopharyngeal symptoms and findings in patients with reflux disease. METHOD: A PRISMA systematic review was conducted in PubMed, Scopus, and the Cochrane Library to identify prospective, retrospective, and randomized studies reporting laryngopharyngeal symptom or sign outcomes after Stretta in adults with suspected or confirmed laryngopharyngeal reflux disease (LPRD) or gastroesophageal reflux disease (GERD). Risk of bias was assessed using the Clarity Group tool and MINORS. RESULTS: Thirteen studies, including 7 prospective studies, 4 retrospective studies, and 2 randomized controlled trials, were eligible, representing 848 patients with reflux disease. All studies included patients with GERD and laryngopharyngeal symptoms, but none objectively confirmed LPRD using pharyngeal pH-impedance monitoring. Cough and hoarseness were the most frequently assessed symptoms and improved in most case series over 3- to 12-month follow-up. Available data also suggested improvement in wheezing or breathing complaints. Proton pump inhibitor discontinuation rates after Stretta ranged roughly from 40% to 80%. No major complications were reported. Studies reported significant heterogeneity for inclusion criteria, laryngopharyngeal symptom outcomes, and success rate definition. CONCLUSION: Current evidence is insufficient to establish the effectiveness or indications of Stretta for patients with GERD and laryngopharyngeal symptoms. Future prospective controlled studies should focus on patients with objectively confirmed LPRD using ambulatory pharyngeal pH-impedance monitoring.