Transoral incisionless fundoplication for treatment of gastroesophageal reflux disease in clinical practice

Abstract

BackgroundTransoral incisionless fundoplication is a recently introduced endoluminal technique for the treatment of gastroesophageal reflux disease (GERD). The objective of this study was to determine outcomes in chronic GERD patients who were referred for surgical management.MethodsA cohort of 38 patients underwent transoral incisionless fundoplication (TIF) in a tertiary care setting. Pre- and post-procedure assessment included GERD-related quality of life questionnaires, proton pump inhibitor (PPI) usage, 24-h pH measurements, upper gastrointestinal endoscopy, esophageal manometry, and registration of adverse events. Duration of follow-up was 36 months.ResultsGastroesophageal valves were constructed of 4 cm (range, 4–6) in length and 220° (range, 180–240) in circumference. One serious adverse event occurred, consisting of intraluminal bleeding at a fastener site. Hiatal hernia was completely reduced in 56 % and esophagitis was cured in 47 % of patients. Postprocedure esophageal acid exposure did not significantly improve (p > 0.05). At 36 (range, 29–41) months follow-up 14 patients (36 %) had undergone revisional laparoscopic fundoplication. Quality of life scores of the remaining cohort showed significant improvement (p < 0.0001) and daily use of antisecretory medication was discontinued by 74 %.ConclusionsEndoluminal fundoplication improved quality of life and reduced the need for PPIs in only a subgroup of patients at 3 years follow-up. The amount of patients requiring additional medication and revisional surgery was high.

Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease

“…Unfortunately long-term data regarding efficacy of this device are limited to a small number of subjects and short duration of follow-up ( 97 ). A recent study suggested that at 36 months of follow-up, the majority of patients had required additional medical therapy or a revisional fundoplication ( 98 ).…”

Does Measurement of Esophagogastric Junction Distensibility by EndoFLIP Predict Therapy- responsiveness to Endoluminal Fundoplication in Patients With Gastroesophageal Reflux Disease?

“…Six months after TIF, GERD symptoms had improved according to the reduction in GERD-HRQL scores (from 26 [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]) to 10 [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20], P < 0.01). Common use of acid suppressive medication was discontinued by 67% of patients, whereas 19% used PPIs occasionally and common use was present in 14%.…”

“…[6][7][8] Previous studies have attempted to identify patient characteristics and objective parameters like lower esophageal sphincter (LES) resting pressure and the number of fasteners that may help to predict treatment outcome of the TIF procedure. 9,10 However, up to now, no objective parameter is available to select patients for this endoluminal procedure. Increased esophagogastric junction (EGJ) distensibility is considered a pathophysiologic factor in GERD as EGJ compliance determines the opening diameter of the EGJ and consequently the volume of reflux content into the esophagus.…”

New Options for the Management of GERD

“…First, a total of 5 (13.5 %) patients underwent additional procedures within 3-6 months including two patients who had a repeat TIF procedure and 3 that subsequently underwent LNF [16]. However, in a series of 38 patients at 36 months follow-up, 37 % (14/38) of patients requested revisional LNF because of persistent GERD symptoms [17]. Further analysis of patients undergoing conversion from TIF to LNF have shown no increased operative morbidity [19].…”

“…Comparatively, in a different study, only 8/19 (42 %) of patients were completely off PPIs, while 32 % (6/19) were taking occasional PPIs and 26 % (5/19) were taking daily PPIs at 36 months [17]. Most patients that had dysphagia before the procedure had improved swallowing after TIF (24/27, 89 %), and no patients developed new dysphagia [14 • ].…”