Statements & Guidelines

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THE STRETTA PROCEDURE - THE SAGES PERSPECTIVE

1. SAGES council notes and recognises the issues of cost effectiveness in the South African environment. 
   
2. There is no standardised data base for SA use which will cover all aspects and needs of the health environment. 
   
3. The GORD spectrum and issues of discussion are:
   

• Cost of medicines and treatment in SA.
  
• Chronic medication. For whom and for how long.
  
• Required and enforced policies regarding clinically untried generic medications. 
  
• Anti-reflux surgery and the present controversies.
  
• Quality control and peer review between family practice, specialist practice and gastro-enterology.
  

INCLUSION AND EXCLUSION CRITERIA

INCLUSION CRITERIA

• Heartburn, regurgitation or both.
  
• Manometric demonstration of adequate oesophageal peristalsis (LESP of more than 5mmHg.
  
• Twenty four hour pH study demonstrating either: total acid exposure time greater than 4% or a De Meester composite score greater than 14.7%.
  
• Responsive to PPI therapy, but with symptomatic relapse on discontinuation.
  
• Subject older than 18 years of age. 
  

EXCLUSION CRITERIA

• Hiatal hernia > 2cms.
  
• significant dysphagia or gas-bloat.
  
• Oesophagitis Grades III or IV by SAVARY criteria.
  
• Barrett’s metaplasia.
  
• Inadequate oesophageal peristalsis or incomplete LESP relaxation.
  
• Complicating medical conditions (endocarditis risk, uncontrolled hypertension, diabetes mellitus, heart disease, steroids, NSAID or immuno-suppressive use and cardiac pacemaker).
  
• Abnormal blood coagulation or use of anti-coagulant or anti-platelet therapies. 
  
• 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