Yiheng Yao; Guolei Shi; Liang Liu

doi:10.5946/ce.2025.220

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Letter to the Editor Comment on ‘The comparative study of Stretta radiofrequency and anti-reflux mucosectomy in the management of intractable gastroesophageal reflux disease: a single-center retrospective study from Korea’: Yiheng Yao¹, Guolei Shi², Liang Liu³; Clinical Endoscopy 2025;58(5):782-783.
DOI: https://doi.org/10.5946/ce.2025.220
Published online: September 2, 2025

¹School of Clinical Medicine, Shandong Second Medical University, Weifang, China

²Department of Digestive Endoscopy Center, Central Hospital Affiliated to Shandong First Medical University, Jinan, China

³Department of Gastroenterology, Central Hospital Affiliated to Shandong First Medical University, Jinan, China

Correspondence: Liang Liu Department of Gastroenterology, Central Hospital Affiliated to Shandong First Medical University, 105 Jiefang Road, Lixia District, Jinan, 250011 Shandong, China E-mail: lleveryground@163.com

• Received: July 8, 2025 • Revised: July 20, 2025 • Accepted: July 21, 2025

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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REFERENCES

See the article "The comparative study of Stretta radiofrequency and anti-reflux mucosectomy in the management of intractable gastroesophageal reflux disease: a single-center retrospective study from Korea" on page 409.

Dear editor,

We read with great interest the article by Lee et al.¹ titled “The comparative study of Stretta radiofrequency and anti-reflux mucosectomy in the management of intractable gastroesophageal reflux disease: a single-center retrospective study from Korea”. The global incidence of intractable gastroesophageal reflux disease (IGERD) has been steadily increasing, with the Asia-Pacific region accounting for approximately one third of the total incidence of the disease.² IGERD has significantly affected patients' study and quality of life. Although proton pump inhibitors can be a treatment method for IGERD, patients’ symptoms are prone to recurrence, and long-term medication can induce complications such as refractory intestinal infections.³ This study evaluated the therapeutic effects of Stretta radiofrequency (SRF) and anti-reflux mucosectomy (ARMS) in the management of IGERD. Here, we would like to share the following observations and our perspective regarding this work.

First, it did not provide a specific formula for calculating the sample size. The sample size should be determined based on factors such as the research objectives, expected effect size, research significance level, and statistical power. The lack of a predetermined sample size may result in an insufficient sample size, making it impossible to detect actual effects, or an excessive sample size, leading to resource waste.

Second, patients who underwent ARMS or SRF between March 2021 and April 2023, a relatively broad time span, which may introduce variability in the treatment conditions. Additionally, several patients were lost to follow-up. Relevant designs and preparations should be made in advance to reduce the number of patients lost to follow-up. If the rate of loss to follow-up is high, the authenticity, generalizability, and statistical power of the study may be affected. Additionally, the postoperative follow-up period should be further extended to compare the long-term efficacy of the two methods and dynamic changes in patient conditions.

Third, this study was a single-center survey conducted by a high-level research institution in the capital of South Korea, which may limit the generalizability and practical applicability of the findings. If feasible, multicenter randomized controlled trials should be conducted in the future to reduce selection bias and to conduct a detailed and comprehensive evaluation of patients' overall quality of life after surgery, including diet, sleep, emotions, somatic symptoms, and upper gastrointestinal symptoms.

This article has a clear and concise framework, reasonable design, and relatively reliable conclusions that provide strong data support for clinical diagnosis and treatment practice. In conclusion, the ARMS group showed significantly better changes in the flap valve grade, EndoFLIP distensibility index, and endoscopic Los Angeles grade than the SRF group. No statistical differences in improvements in gastroesophageal reflux disease questionnaire scores and proton pump inhibitor withdrawal rates were observed between the two groups. The incidence of complications was higher in the ARMS group than in the SRF group. In summary, each of the above two methods has its own advantages in treating IGERD. As reported by Joel et al.,⁴ SRF is a feasible and safe method for treating refractory gastroesophageal reflux disease, especially in younger patients. In clinical practice, we should comprehensively consider factors such as patient age, lesion characteristics and types, and disease duration and determine the most suitable treatment method.

Conflicts of Interest

The authors have no potential conflicts of interest.

Funding

This study was funded by the special funding for high-level talent in the medical and health industries of Jinan (202412).

Author Contributions

Conceptualization: YY, GS; Supervision: all authors; Visualization: LL; Writing–original draft: LL; Writing–review & editing: all authors.

REFERENCES

1. Lee AY, Choi JW, Heo JH, et al. The comparative study of Stretta radiofrequency and anti-reflux mucosectomy in the management of intractable gastroesophageal reflux disease: a single-center retrospective study from Korea. Clin Endosc 2025;58:409–417.Article PubMed PMC PDF
2. Jung HK. Epidemiology of gastroesophageal reflux disease in Asia: a systematic review. J Neurogastroenterol Motil 2011;17:14–27.Article PubMed PMC
3. Lo WK, Chan WW. Proton pump inhibitor use and the risk of small intestinal bacterial overgrowth: a meta-analysis. Clin Gastroenterol Hepatol 2013;11:483–490.Article PubMed
4. Joel A, Konjengbam A, Viswanath Y, et al. Endoscopic radiofrequency Stretta therapy reduces proton pump inhibitor dependency and the need for anti-reflux surgery for refractory gastroesophageal reflux disease. Clin Endosc 2024;57:58–64.Article PubMed PMC PDF

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Comment on ‘The comparative study of Stretta radiofrequency and anti-reflux mucosectomy in the management of intractable gastroesophageal reflux disease: a single-center retrospective study from Korea’

Clin Endosc. 2025;58(5):782-783. Published online September 2, 2025

DOI: https://doi.org/10.5946/ce.2025.220

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