Abstract
Gastroesophageal reflux disease (GERD) is a very common disorder that can be currently treated by medical therapy, surgery, or endoscopic transoral interventions. Medical therapy is the most common approach. However, concerns have been raised in recent years with regard to the potential side effects of continuous long-term medication, drug intolerance or unresponsiveness, and the need for high dosages for long periods to treat symptoms or prevent recurrences. Surgery may have in some cases consequences such as long-lasting dysphagia, flatulence, inability to belch or vomit, diarrhea, or functional dyspepsia related to delayed gastric emptying. Transoral incisionless fundoplication (TIF) has recently been proved to be an effective therapeutic option as an alternative to medical and surgical therapy. TIF reconfigures the tissue to obtain a full-thickness gastro-esophageal valve from inside the stomach, through serosa-to-serosa plications including the muscle layers. This chapter describes the TIF technique with the two most common used devices: the EsophyX fastener delivery system (EsophyX®) and the Medigus ultrasonic surgical endostapler (MUSE™) system. Techniques, steps, complications, and indications are described in detail. Moreover, the recent literature regarding TIF outcomes is reviewed. To date TIF has achieved long-lasting improvement of GERD symptoms (up to 10 years), with cessation or reduction of proton pump inhibitor medication in about 75% of patients, as well as improvement of functional findings.
Similar content being viewed by others
References
Kahrilas PJ et al (2012) Regurgitation is less responsive to acid suppression than heartburn in patients with gastroesophageal reflux disease. Clin Gastroenterol Hepatol 10:612–619
Brusselaers N et al (2017) Maintenance therapy with proton pump inhibitors and risk of gastric cancer: a nationwide population-based cohort study in Sweden. BMJ Open 30:e017739. Epub 2019 Aug 21
Brusselaers N et al (2018) Maintenance proton pump inhibition therapy and risk of oesophageal cancer. Cancer Epidemiol 53:172–177
Lundell L et al (2001) Continued (5 years) follow up of a randomized clinical study comparing antireflux surgery and omeprazole in GERD. J Am Col Surg 192:171–182
Draaisma WE et al (2006) Five-year subjective and objective results of laparoscopic and conventional Nissen fundoplication. Ann Surg 244:34–41
Smith CD (2009) Surgical therapy for gastroesophageal reflux disease: indications, evaluation and procedures. Gastrointest Endoscopy Clin N Am 19:35–48
Broeders JA et al (2010) Long-term outcome of Nissen fundoplication in non-erosive and erosive gastro-esophageal reflux disease. Br J Surg 97:845–852
Alemanno G et al (2017) A long-term evaluation of the quality of life after laparoscopic Nissen-Rossetti anti-reflux surgery. J Minim Access Surg 13:208–214
Bowrey DJ et al (2001) Risk factors and the prevalence of trocar site herniation after laparoscopic fundoplication. Surg Endosc 15:663–666
Nicolau AE, Lobonţiu A (2018) Transoral Incisionless fundoplication TIF 2.0 with “EsophyX Z®” device for GERD: seven years after endolumenal fundoplication. World’s first case report. Chirurgia 113:849–856
Kauer WK et al (2009) Preclinical trial of a modified gastroscope that performs a true anterior fundoplication for the endoluminal treatment of gastroesophageal reflux disease. Surg Endosc 23:2728–2731
Gweon TG, Matthes K (2016) Prospective, randomized ex vivo trial to assess the ideal stapling site for endoscopic fundoplication with medigus ultrasonic surgical endostapler. Gastroenterol Res Pract 2016:3161738. Epub 2016 Jul 31
Stefanidis D et al (2010) SAGES guidelines committee. Guidelines for surgical treatment of gastroesophageal reflux disease. Surg Endosc 11:2647–2669
Cadiere GB et al (2008) Endoluminal fundoplication by a transoral device for the treatment of GERD: a feasibility study. Surg Endosc 22:333–342
Testoni PA et al (2012) Transoral incisionless fundoplication (TIF 2.0) with Esophyx for gastroesophageal reflux disease: long-term results and findings affecting outcome. Surg Endosc 26:1425–1435
Bell RC, Cadière GB (2011) Transoral rotational esophagogastric fundoplication: technical, anatomical, and safety considerations. Surg Endosc 25:2387–2399
Huang X et al (2017) Efficacy of transoral incisionless fundoplication (TIF) for the treatment of GERD: a systematic review with meta-analysis. Surg Endosc 31:1032–1044
McCarty TR et al (2018) Efficacy of transoral incisionless fundoplication for refractory gastro-esophageal reflux disease: a systematic review and meta-analysis. Endoscopy 50:708–725
Roy-Shapira A et al (2015) Trans-oral anterior fundoplication: 5-year follow-up of pilot study. Surg Endosc 29:3717–3721
Zacheri J et al (2015) Endoscopic anterior fundoplication with the Medigus Ultrasonic Surgical Endostapler (MUSE) for gastroesophageal reflux: 6-month results from a multi-center prospective trial. Surg Endosc 29:220–229
Kim HJ et al (2016) Long-term follow-up results of endoscopic treatment of gastroesophageal reflux disease with the MUSE™ endoscopic stapling device. Surg Endosc 30:3402–3408
Demyttenaere SV et al (2010) Transoral incisionless fundoplication for gastro-esophageal reflux disease in an unselected patient population. Surg Endosc 24:854–858
Frazzoni M et al (2011) Reflux parameters as modified by EsophyX or laparoscopic fundoplication in refractory GERD. Aliment Pharmacol Ther 34:67–75
Cadière GB et al (2008) Antireflux transoral incisionless fundoplication using EsophyX: 12-month results of a prospective multicenter study. World J Surg 32:1676–1688
Repici A et al (2010) Endoluminal fundoplication (ELF) for GERD using Esophyx: a 12-month follow-up in a single-center experience. J Gastrointest Surg 14:1–6
Wilson EB et al (2014) The effects of transoral incisionless fundoplication on chronic GERD patients: 12-month prospective multicenter experience. Surg Laparosc Endosc Percutan Tech 24:36–46
Muls V et al (2013) Three-year results of a multicenter prospective study of transoral incisionless fundoplication. Surg Innov 20:321–330
Testoni PA et al (2010) Effect of transoral incisionless fundoplication on symptoms, PPI use, and pH-impedance refluxes of GERD patients. World J Surg 34:750–757
Witteman PBL et al (2012) Transoral incisionless fundoplication for treatment of gastroesophageal reflux diseases in clinical practice. Surg Endosc 26:3307–3315
Testoni PA et al (2015) Long term efficacy of transoral incionless fundoplication with Esophyx (TIF 2.0) and factors affecting outcomes in GERD patients followed for up to 6 years: a prospective single-center study. Surg Endosc 29:2770–2780
Hoppo T et al (2010) Transoral incisionless fundoplication 2.0 procedure using EsophyX™ for gastroesophageal reflux disease. J Gastrointest Surg 14:1895–1901
Ihde GM et al (2019) pH scores in hiatal repair with Transoral Incisionless fundoplication. JSLS 23:1–8
Trad K et al (2017) Transoral fundopliication offers durable symptom control for chronic GERD: 3-year report from the TEMPIO randomized trial with a crossover arm. Surg Endosc 31:2498–2508
Hunter GJ et al (2015) Efficacy of transoral fundoplication vs omeprazole for treatment of regurgitation in a randomized controlled trial. Gastroenterology 148:324–333
Hakansson B et al (2015) Randomised clinical trial: transoral incisionless fundoplication vs. sham intervention to control chronic GERD. Aliment Pharmacol Ther 42:1261–1270
Rinsma NF et al (2015) The effect of endoscopic fundoplication and proton pump inhibitors on baseline impedance and heartburn severity in GERD patients. Neurogastroenterol Motil 27:220–228
Trad KS et al (2015) Transoral incisionless fundoplication effective in eliminating GERD symptoms in partial responders to proton pump inhibitor therapy at 6 months: the TEMPO randomized clinical trial. Surg Innov 22:26–40
Stefanidis G et al (2017) Long-term benefit of transoral incisionless fundoplication using the Esophyx device for the management of gastroesophageal reflux disease responsive to medical therapy. Dis Esophagus 30:1–8
Trad KS et al (2014) Efficacy of transoral fundoplication for treatment of chronic gastroesophageal reflux disease incompletely controlled with high-dose proton-pump inhibitors therapy: a randomized, multicenter, open label, crossover study. BMC Gastroenterol 14:174–186
Trad KS et al (2018) The TEMPO trial at 5 years: transoral fundoplication (TIF 2.0) is safe, durable, and cost-effective. Surg Innov 25:149–157
Testoni PA et al (2019) Transoral incisionless fundoplication with EsophyX for gastroesophageal reflux disease: clinical efficacy is maintained up to 10 years. Endosc Int Open 7:E647–E654
Chimukangara M et al (2019) Long-term reported outcomes of transoral incisionless fundoplication: an 8-year cohort study. Surg Endosc 33:1304–1309
Barnes WE et al (2011) Transoral incisionless fundoplication offers high patient satisfaction and relief of therapy-resistant typical and atypical symptoms of GERD in community practice. Surg Innov 18:119–129
Richter JE et al (2018) Efficacy of laparoscopic Nissen fundoplication vs transoral Incisionless fundoplication or proton pump inhibitors in patients with gastroesophageal reflux disease: a systematic review and network meta-analysis. Gastroenterology 154:1298–1308
Loedrup A et al (2014) Use of proton pump inhibitors after antireflux surgery. A nationwide register-based follow-up study. Gut 63:1544–1549
Garg SK, Gurusamy KS (2015) Laparoscopic fundoplication surgery versus medical management for gastro-oesophageal reflux disease (GORD) in adults. Cochrane Database Syst Rev (11):CD003243
Lundell L et al (2014) Systematic review: laparoscopic fundoplication for gastro-esophageal reflux disease in partial responders to proton pump inhibitors. World J Gastroenterol 20:804–813
Kelly JJ et al (2007) Laparoscopic Nissen fundoplication: clinical outcomes at 10 years. J Am Coll Surg 205:570–575
Gunter RL et al (2017) Long-term quality of life outcomes following Nissen versus Toupet fundoplication in patients with gastroesophageal reflux disease. J Laparoendosc Adv Surg Tech A 27:931–936
Bell RC et al (2012) A prospective multicenter registry of patients with chronic gastro-esophageal reflux disease receiving transoral incisionless fundoplication. J Am Coll Sur 215:794–809
Bell RCW et al (2013) Revision of failed traditional fundoplication using Esophyx transoral fundoplication. Surg Endosc 27:761–767
Bell RC et al (2014) Univariate and multivariate analysis of preoperative factors influencing symptomatic outcomes of transoral fundoplication. Surg Endosc 28:2949–2958
Svoboda P et al (2011) Our experience with transoral incisionless plication of gastroesophageal reflux disease: NOTES procedure. Hepato-Gastroenterology 109:1208–1213
Fumagalli Romario U et al (2011) Nissen fundoplication after failure of endoluminal fundoplication: short-term results. J Gastrointest Surg 15:439–443
Furnée EJ et al (2010) Laparoscopic Nissen fundoplication after failed Esophyx fundoplication. Br J Surg 97:1051–1055
Janu P et al (2019) Laparoscopic hiatal hernia repair followed by transoral incisionless fundoplication with EsophyX device (HH + TIF): efficacy and safety in two community hospitals. Surg Innov 26:675–686
Robertson JO, Jarboe MD (2018) Long-term outcomes of transoral incisionless fundoplication in a high-risk pediatric population. J Laparoendosc Adv Surg Tech 28:95–100
Tyberg A et al (2018) Transoral incisionless fundoplication for reflux after peroral endoscopic myotomy: a crucial addition to our arsenal. Endosc Int Open 06:E549–E552
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Section Editor information
Rights and permissions
Copyright information
© 2021 Springer Nature Switzerland AG
About this entry
Cite this entry
Testoni, S.G.G., Fanti, L., Testoni, P.A. (2021). Transoral Fundoplication for Treatment of Gastroesophageal Reflux Disease. In: Testoni, P.A., Inoue, H., Wallace, M.B. (eds) Gastrointestinal and Pancreatico-Biliary Diseases: Advanced Diagnostic and Therapeutic Endoscopy. Springer, Cham. https://doi.org/10.1007/978-3-030-29964-4_38-1
Download citation
DOI: https://doi.org/10.1007/978-3-030-29964-4_38-1
Received:
Accepted:
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-29964-4
Online ISBN: 978-3-030-29964-4
eBook Packages: Springer Reference MedicineReference Module Medicine