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Transoral incisionless fundoplication (TIF 2.0) with EsophyX for gastroesophageal reflux disease: long-term results and findings affecting outcome

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Abstract

Introduction

Transoral incisionless fundoplication (TIF) with the EsophyX device is reported to be effective for creating a continent gastroesophageal valve and for good functional results, as measured by pH impedance in patients with gastroesophageal reflux disease (GERD). The aim of this study is to assess the long-term effect of TIF in patients with symptomatic GERD.

Patients and methods

TIF 2.0 fundoplication was done in 42 consecutive patients. All were studied with GERD-HRQL and GERD-QUAL questionnaires, upper gastrointestinal (GI) endoscopy, esophageal manometry, and 24 h pH impedance before and at 6, 12, and 24 months after TIF.

Results

In all, 35 patients completed 6-month follow-up; 21 (60.0%) completely stopped proton pump inhibitor (PPI) therapy, 6 (17.1%) more than halved it, and 8 (22.9%) continued with the same dose as before the procedure. There were 26 patients with complete 24-month follow-up; 11 (42.3%) completely stopped PPI therapy, 7 (26.9%) more than halved it, and 8 (30.8%) were taking the same dose as before the procedure. Hiatal hernia and ineffective esophageal motility seemed to raise the risk of recurrence of symptoms (p = 0.02 and p < 0.001, respectively). The number of fasteners deployed during TIF was the only factor predictive of successful outcome (p = 0.018).

Conclusions

TIF using the EsophyX device allowed withdrawal or reduction of PPI in about 77% of patients at 6-month follow-up and about 69% at 24 months. Larger number of fasteners deployed during TIF was predictive of positive outcome; pre-TIF ineffective esophageal motility and hiatal hernia raised the risk of recurrence of GERD symptoms, but were not significant from a prospective point of view.

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Abbreviations

GER:

Gastroesophageal reflux

GERD:

Gastroesophageal reflux disease

LES:

Lower esophageal sphincter

PPI:

Proton pump inhibitors

TIF:

Transoral incisionless fundoplication

DEA:

Distal esophageal amplitude

SAP:

Symptom association probability

BMI:

Body mass index

IEM:

Ineffective esophageal motility

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Disclosures

Author Cristian Vailati’s data presentation at DDW 2010 was supported by the manufacturer of the device. Authors Pier Alberto Testoni, Sabrina Testoni, and Maura Corsetti have no conflicts of interest or financial ties to disclose.

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Correspondence to Pier Alberto Testoni.

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Testoni, P.A., Vailati, C., Testoni, S. et al. Transoral incisionless fundoplication (TIF 2.0) with EsophyX for gastroesophageal reflux disease: long-term results and findings affecting outcome. Surg Endosc 26, 1425–1435 (2012). https://doi.org/10.1007/s00464-011-2050-1

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