Sphincter disorders, especially of the entry (esophageal) & exit (anal) sphincters are the commonest, that have limited treatment options. Gastro-Esophageal-Reflux disease (GERD), the most common of the sphincter disorders is managed by medical management successful in mild to moderate cases. However, there have been numerous reports on failures due to refractory symptoms and non-compliance of patients as well. Such patients will be subjected to surgical management with laparoscopic fundoplication, which involves making incisions in the torso and wrapping part of the stomach around the base of the esophagus which is considered the gold standard for efficacy. However, surgery posts its own risks and post-operative issues.
Anal incontinence and sphincter incontinence most commonly happens due to previous surgeries, delivery and trauma to the anal region. Anal incontinence does not have a clear management protocol due to its high failure rates.
Mederi Inc, a US based company has introduced endoscopic management for the same by the way of endoscopic non-ablative radiofrequency ablation of the sphincters that delivers radiofrequency energy in the form of electromagnetic waves through electrodes at the end of a catheter to the sphincters. The energy heats the tissue, ultimately causing it to swell and stiffen causing local inflammation, collagen deposition and hypertrophy of the muscles of the sphincter thus increasing the sphincter pressure and thus treating the incontinence.
Stretta is a minimally invasive endoscopic procedure for the treatment of gastroesophageal reflux disease (GERD) that delivers NARF energy to the lower esophageal sphincter (LES) and the gastric cardia – the region of the stomach just below the LES. It is relatively safe and efficient. In 2015, the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) gave it a strong recommendation for people who refuse surgery or failed medical management. Stretta comes as a relief to post bariatric GERD where the surgical options cannot be considered due to non availability of stomach for the wrap. Prospective studies are on the way for concomitant and post bariatric Stretta therapy for GERD in morbidly obese patients.
Secca is a similar procedure for bowel control disease (anal incontinence) which utilizes NARF to remodel the anal sphincter muscle, thereby improving function, significant symptom relief, and dramatic improvement in quality-of-life.
Both the procedures are used by gastroenterologists, general surgeons, bariatric surgeons, ENT surgeons, urogynecologists, colorectal surgeons and thoracic surgeons. These products fill the treatment gap between medications and surgery with up to 93% patient satisfaction and have good results lasting to 10 years. There has been few randomized control studies and meta-analysis proving its safety and efficacy. As of date, it is the only successful non-surgical option available in the industry.
Apollo Hospitals, being a fore runner in imbibing technologies, has taken the initiative along with Healthware technologies to introduce this treatment option commercially into India. Institute of Bariatrics & Institute of Gastrosciences at Apollo Hospitals, Greams Road, Chennai, conducted the first of its kind workshop on Stretta on 31st October, 2016. Mr. Graeme Smith, Managing Director of Mederi and Dr. Rakesh Kalpalla, Senior Gastroenterologist from Asian Institute of Gastroenterology, Hyderabad, presided over the workshop enumerating the salient features and tips of this procedure and the workshop was attended by numerous senior consultants. Dr. Rakesh also demonstrated two Stretta procedures, one for a refractory GERD with Hiatus hernia and another for a post sleeve gastrectomy GERD. Both the procedures were performed as out-patient services under sedation and patients were sent home within 2 hours after the procedure.
Dr. Raj Palaniappan, Director of Bariatric Institute, who organized the event mentioned that Stretta & Secca are here to stay and are going to revolutionize the non-surgical sphincter therapy and that this is a very useful option complementing medical and surgical treatments alike. He also mentioned that it is the first time in India that Stretta therapy is being offered to a post-bariatric GERD patient.
The event was inaugurated by Dr. Satyabhama, DMS & Dr. Subbiah, COO of Apollo Hospitals, Greams Road along with Dr. K.R. Palaniswamy & Prof. Prasanna Kumar Reddy, Senior Gastroenterologists from Apollo Hospitals, Greams Road, Chennai.
