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Transoral Incisionless Fundoplication (TIF) for Treatment of Gastroesophageal Reflux Disease

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Gastrointestinal Interventional Endoscopy

Abstract

Gastroesophageal reflux disease (GERD) is a very common disorder that results primarily from the loss of an effective anti-reflux barrier. GERD can be currently treated by medical therapy and surgical or endoscopic transoral intervention. Medical therapy is the most common approach. However, concerns have been increasingly 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 gastroesophageal 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. Technique steps and complications and their management are described in detail. Moreover, the recent literature regarding their 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.

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References

  1. Lundell L, Miettinen P. Continued (5 years) follow up of a randomized clinical study comparing antireflux surgery and omeprazole in GERD. J Am Coll Surg. 2001;192:171–82.

    Google Scholar 

  2. Draaisma WE, Rijnhart-de Jong HG, Broeders IAMJ, Smout AJ, Furnee EJ, Gooszen HG. Five-year subjective and objective results of laparoscopic and conventional Nissen fundoplication. Ann Surg. 2006;244:34–41.

    Article  Google Scholar 

  3. Smith CD. Surgical therapy for gastroesophageal reflux disease: indications, evaluation and procedures. Gastrointest Endosc Clin N Am. 2009;19:35–48.

    Article  Google Scholar 

  4. Broeders JA, Draaisma WA, Bredenoord AJ, Smout AJ, Broeders IA, Gooszen HG. Long-term outcome of Nissen fundoplication in non-erosive and erosive gastro-esophageal reflux disease. Br J Surg. 2010;97:845–52.

    Article  CAS  Google Scholar 

  5. Alemanno G, Bergamini C, Prosperi P, Bruscino A, Leahu A, Somigli R, Martellucci J, Valeri A. A long-term evaluation of the quality of life after laparoscopic Nissen-Rossetti anti-reflux surgery. J Minim Access Surg. 2017;13:208–14.

    PubMed  PubMed Central  Google Scholar 

  6. Cadiere GB, Rajan A, Germay O, Himpens J. Endoluminal fundoplication by a transoral device for the treatment of GERD: a feasibility study. Surg Endosc. 2008;22:333–42.

    Article  CAS  Google Scholar 

  7. Testoni PA, Vailati C, Testoni S, Corsetti M. Transoral incisionless fundoplication (TIF 2.0) with Esophyx for gastroesophageal reflux disease: long-term results and findings affecting outcome. Surg Endosc. 2012;26:1425–35.

    Article  Google Scholar 

  8. Bell RC, Cadière GB. Transoral rotational esophagogastric fundoplication: technical, anatomical, and safety considerations. Surg Endosc. 2011;25:2387–99.

    Article  Google Scholar 

  9. Kauer WK, Roy-Shapira A, Watson D, Sonnenschein M, Sonnenschein E, Unger J, Voget M, Stein HJ. Preclinical trial of a modified gastroscope that performs a true anterior fundoplication for the endoluminal treatment of gastroesophageal reflux disease. Surg Endosc. 2009;23:2728–31.

    Article  Google Scholar 

  10. Huang X, Chen S, Zhao H, Zeng X, Lin J, Tseng Y, Chen J. Efficacy of transoral incisionless fundoplication (TIF) for the treatment of GERD: a systematic review with meta-analysis. Surg Endosc. 2017;31:1032–44.

    Article  Google Scholar 

  11. Roy-Shapira A, Bapaye A, Date S, Pujari R, Dorwat S. Trans-oral anterior fundoplication: 5-year follow-up of pilot study. Surg Endosc. 2015;29(12):3717–21.

    Article  Google Scholar 

  12. Zacheri J, Roy-Shapira A, Bonavina L, Bapaye A, Kiesslich R, Schoppmann SF, Kessler WR, Selzer DJ, Broderick RC, Lehman GA, Horgan S. Endoscopic anterior fundoplication with the Medigus ultrasonic surgical endostapler (MUSE) for gastroesophageal reflux: 6-month results from a multi-center prospective trial. Surg Endosc. 2015;29:220–9.

    Article  Google Scholar 

  13. Kim HJ, Kwon CI, Kessler WR, Selzer DJ, McNulty G, Bapaye A, Bonavina L, Lehman GA. Long-term follow-up results of endoscopic treatment of gastroesophageal reflux disease with the MUSE™ endoscopic stapling device. Surg Endosc. 2016;30:3402–8.

    Article  Google Scholar 

  14. Demyttenaere SV, Bergman S, Pham T, Anderson J, Dettorre R, Melvin WS, Mikami DJ. Transoral incisionless fundoplication for gastro-esophageal reflux disease in an unselected patient population. Surg Endosc. 2010;24:854–8.

    Article  Google Scholar 

  15. Frazzoni M, Conigliaro R, Manta R, Melotti G. Reflux parameters as modified by EsophyX or laparoscopic fundoplication in refractory GERD. Aliment Pharmacol Ther. 2011;34:67–75.

    Article  CAS  Google Scholar 

  16. Cadière GB, Buset M, Muls V, Rajan A, Rösch T, Eckardt AJ, Weerts J, Bastens B, Costamagna G, Marchese M, Louis H, Mana F, Sermon F, Gawlicka AK, Daniel MA, Devière J. Antireflux transoral incisionless fundoplication using EsophyX: 12-month results of a prospective multicenter study. World J Surg. 2008;32:1676–88.

    Article  Google Scholar 

  17. Repici A, Fumagalli U, Malesci A, Barbera R, Gambaro C, Rosati R. Endoluminal fundoplication (ELF) for GERD using Esophyx: a 12-month follow-up in a single-center experience. J Gastrointest Surg. 2010;14:1–6.

    Article  Google Scholar 

  18. Testoni PA, Corsetti M, Di Pietro S, Castellaneta AG, Vailati C, Masci E, Passaretti S. Effect of transoral incisionless fundoplication on symptoms, PPI use, and pH-impedance refluxes of GERD patients. World J Surg. 2010;34:750–7.

    Article  Google Scholar 

  19. Petersen R, Filippa L, Wassenaar EB, Martin AV, Tatum R, Oelschlager BK. Comprehensive evaluation of endoscopic fundoplication using the Esophyx device. Surg Endosc. 2012;26:1021–7.

    Article  Google Scholar 

  20. Witteman PBL, Strijkers R, de Vries E, Toemen L, Conchillo JM, Hameeteman W, Dagnelie PC, Koek GH, Bouvy ND. Transoral incisionless fundoplication for treatment of gastroesophageal reflux diseases in clinical practice. Surg Endosc. 2012;26:3307–15.

    Article  Google Scholar 

  21. Bell RC, Mavrelis PG, Barnes WE, Dargis D, Carter BJ, Hoddinott KM, Sewell RW, Trad KS, DaCosta Gill B, Ihde GM. A prospective multicenter registry of patients with chronic gastro-esophageal reflux disease receiving transoral incisionless fundoplication. J Am Coll Surg. 2012;215:794–809.

    Article  Google Scholar 

  22. Wilson EB, Barnes WE, Mavrelis PG, Carter BJ, Bell RCW, Sewell RW, Ihde GM, Dargis D, Hoddinott KM, Shughoury AB, Gill BD, Fox MA, Turgeon DG, Freeman KD, Gunsberger T, Hausmann MG, Leblanc KA, Deljkich E, Trad KS. The effects of transoral incisionless fundoplication on chronic GERD patients: 12-month prospective multicenter experience. Surg Laparosc Endosc Percutan Tech. 2014;24:36–46.

    Article  Google Scholar 

  23. Testoni PA, Testoni S, Mazzoleni G, Vailati C, Passaretti S. Long-term efficacy of transoral incisionless fundoplication with Esophyx (TIF 2.0) and factors affecting outcomesin GERD patients followed for up to 6 years: a prospective single-center study. Surg Endosc. 2015;29:2770–80.

    Article  Google Scholar 

  24. Muls V, Eckardt AJ, Marchese M, Bastens B, Buset M, Devière J, Louis H, Rajan A, Daniel MA, Costamagna G. Three-year results of a multicenter prospective study of transoral incisionless fundoplication. Surg Innov. 2013;20(4):321–30.

    Article  Google Scholar 

  25. Cadière GB, Van Sante N, Graves JE, Gawlicka AK, Rajan A. Two-year results of a feasibility study on antireflux transoral incisionless fundoplication using Esophyx. Surg Endosc. 2009;23:957–64.

    Article  Google Scholar 

  26. Hoppo T, Immanuel A, Schuchert M, Dubrava Z, Smith A, Nottle P, Watson DI, Jobe BA. Transoral incisionless fundoplication 2.0 procedure using EsophyX™ for gastroesophageal reflux disease. J Gastrointest Surg. 2010;14:1895–901.

    Article  Google Scholar 

  27. Trad K, Fox MA, Simoni G, Shughoury AB, Mavrelis PG, Raza M, Helse JA, Barnes WE. Transoralfundopliication offers durable symptom control for chronic GERD: 3-year report from the TEMPIO randomized trail with a crossover arm. Surg Endosc. 2017;31:2498–508.

    Article  Google Scholar 

  28. Barnes WE, Hoddinott KM, Mundy S, et al. Transoral incisionless fundoplication offers high patient satisfaction and relief of therapy-resistant typical and atypical symptoms of GERD in community practice. Surg Innov. 2011;18:119–29.

    Article  Google Scholar 

  29. Hunter GJ, Kahrilas PJ, Bell RC, Wilson EB, Trad KS, Dolan JP, Perry KA, Oelschlager BK, Soper NJ, Snyder BE, Burch MA, Melvin WS, Reavis KM, Turgeon DG, Hungness ES, Diggs BS. Efficacy of transoral fundoplication vs omeprazole for treatment of regurgitation in a randomized controlled trial. Gastroenterology. 2015;148:324–33.

    Article  CAS  Google Scholar 

  30. Hakansson B, Montgomery M, Cadiere GB, Rajan A, Bruley des Varannes S, Lerhun M, Coron E, Tack J, Bischops R, Thorell A, Arnelo U, Lundell L. Randomised clinical trial: transoral incisionless fundoplication vs. sham intervention to control chronic GERD. Aliment Pharmacol Ther. 2015;42:1261–70.

    Article  CAS  Google Scholar 

  31. Rinsma NF, Farre´ R, Bouvy ND, Masclee AM, Conchillo JM. The effect of endoscopic fundoplication and proton pump inhibitors on baseline impedance and heartburn severity in GERD patients. Neurogastroenterol Motil. 2015;27:220–8.

    Article  CAS  Google Scholar 

  32. Trad KS, Barnes WE, Simoni G, Shughoury AB, Mavrelis PG, Raza M, Heise JA, Turgeon DG. Fox MA (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. 2015;22:26–40.

    Article  Google Scholar 

  33. Trad KS, Simoni G, Barnes WE, Shughoury AB, Raza M, Heise JA, Turgeon DG, Fox MA, Mavrelis PG. 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. 2014;14:174.

    Article  Google Scholar 

  34. Svoboda P, Kantorová I, Kozumplík L, Scheer P, Radvan M, Radvanová J, Krass V, Horálek F. Our experience with transoral incisionless plication of gastroesophageal reflux disease: NOTES procedure. Hepatogastroenterology. 2011;109:1208–13.

    Article  Google Scholar 

  35. Fumagalli Romario U, Barbera R, Repici A, Porta M, Malesci A, Rosati R. Nissen fundoplication after failure of endoluminal fundoplication: short-term results. J Gastrointest Surg. 2011;15:439–43.

    Article  Google Scholar 

  36. Furnée EJ, Broeders JA, Draaisma WA, Schwartz MP, Hazebroek EJ, Smout AJ, van Rijn PJ, Broeders IA. Laparoscopic Nissen fundoplication after failed Esophyx fundoplication. Br J Surg. 2010;97:1051–5.

    Article  Google Scholar 

  37. Bell RCW, Hufford RJ, Fearon J, Freeman KD. Revision of failed traditional fundoplication using Esophyxtransoral fundoplication. Surg Endosc. 2013;27:761–7.

    Article  Google Scholar 

  38. Kim KY, Kim GH, Kim DU, Wang SG, Lee BJ, Lee JC, Park DY, Song GA. Is ineffective esophageal motility associated with gastropharyngeal reflux disease? World J Gastroenterol. 2008;14:6030–5.

    Article  Google Scholar 

  39. Bell RC, Fox MA, Barnes WE, Mavrelis PG, Sewell RW, Carter BJ, Ihde GM, Trad KS, Dargis D, Hoddinott KM, Freeman KD, Gunsberger T, Hausmann MG, Gill BD, Wilson E. Univariate and multivariate analysis of preoperative factors influencing symptomatic outcomes of transoral fundoplication. Surg Endosc. 2014;28:2949–58.

    Article  Google Scholar 

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Authors and Affiliations

  1. IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Division of Gastroenterology and Gastrointestinal Endoscopy, Milano (MI), Italy

    Pier Alberto Testoni, Sabrina Gloria Giulia Testoni, Giorgia Mazzoleni & Lorella Fanti

Authors
  1. Pier Alberto Testoni
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  2. Sabrina Gloria Giulia Testoni
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  3. Giorgia Mazzoleni
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  4. Lorella Fanti
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Correspondence to Pier Alberto Testoni .

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Editors and Affiliations

  1. Interventional Endoscopy, Division of Gastroenterology, University of Colorado-Denver, Aurora, CO, USA

    Mihir S. Wagh

  2. Interventional Endoscopy, Division of Gastroenterology, University of Colorado-Denver, Aurora, CO, USA

    Sachin B. Wani

Electronic Supplementary Material

TIF 2.0 procedure with EsophyX(R) Z device: with the patient placed under deep sedation, the EsophyX device is introduced into the stomach over a flexible endoscope. The endoscope and the device are retroflexed to visualize the cardias, so that the procedure is under constant visualization. A helical retractor is stuck into the tissue, just below the Z-line, in order to fold up the fundus of the stomach and around the distal esophagus, utilizing the tissue mold and chassis of the device. Thereafter, an integrated suction apparatus is activated to position the distal esophagus in the abdominal cavity, distal to the diaphragm. H-shaped SerosaFuse fasteners are then delivered to seal the serosa-to-serosa plications. This process is repeated to create a full-thickness, partial circumference, gastroesophageal fundoplication (new valve of 2 to 4 cm in length and greater than 270 degree circumferential wrap) (MP4 49264 kb)

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Testoni, P.A., Testoni, S.G.G., Mazzoleni, G., Fanti, L. (2020). Transoral Incisionless Fundoplication (TIF) for Treatment of Gastroesophageal Reflux Disease. In: Wagh, M., Wani, S. (eds) Gastrointestinal Interventional Endoscopy. Springer, Cham. https://doi.org/10.1007/978-3-030-21695-5_23

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  • DOI: https://doi.org/10.1007/978-3-030-21695-5_23

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  • Online ISBN: 978-3-030-21695-5

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