Statements & Guidelines
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THE STRETTA PROCEDURE - THE SAGES PERSPECTIVE
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SAGES council notes and recognises the issues of cost effectiveness in the
South African environment.
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There is no standardised data base for SA use which will cover all aspects and
needs of the health environment.
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The GORD spectrum and issues of discussion are:
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Cost of medicines and treatment in SA.
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Chronic medication. For whom and for how long.
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Required and enforced policies regarding clinically untried generic
medications.
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Anti-reflux surgery and the present controversies.
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Quality control and peer review between family practice, specialist practice
and gastro-enterology.
INCLUSION AND EXCLUSION CRITERIA
INCLUSION CRITERIA
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Heartburn, regurgitation or both.
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Manometric demonstration of adequate oesophageal peristalsis (LESP of more than
5mmHg.
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Twenty four hour pH study demonstrating either: total acid exposure time
greater than 4% or a De Meester composite score greater than 14.7%.
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Responsive to PPI therapy, but with symptomatic relapse on discontinuation.
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Subject older than 18 years of age.
EXCLUSION CRITERIA
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Hiatal hernia > 2cms.
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significant dysphagia or gas-bloat.
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Oesophagitis Grades III or IV by SAVARY criteria.
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Barrett’s metaplasia.
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Inadequate oesophageal peristalsis or incomplete LESP relaxation.
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Complicating medical conditions (endocarditis risk, uncontrolled hypertension,
diabetes mellitus, heart disease, steroids, NSAID or immuno-suppressive use and
cardiac pacemaker).
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Abnormal blood coagulation or use of anti-coagulant or anti-platelet
therapies.
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Poor surgical candidate or reduced life expectancy.
SAGES COUNCIL ALSO NOTES THAT THE FINAL COST STRUCTURES AND ACCREDITATION
SYSTEMS HAVE NOT BEEN PROPOSED AND FINALISED.
Clinical Practice & Guidelines Committee
Dr J. Garsich
Dr C. Ziady
Dr S. Grobler