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

  • Pier Alberto TestoniEmail author
  • Sabrina Gloria Giulia Testoni
  • Giorgia Mazzoleni
  • Lorella Fanti


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.


Gastroesophageal reflux disease Transoral incisionless fundoplication Anterior fundoplication EsophyX MUSE Surgical endostapler Surgical fundoplication 

Supplementary material

Video 23.1

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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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Pier Alberto Testoni
    • 1
    Email author
  • Sabrina Gloria Giulia Testoni
    • 1
  • Giorgia Mazzoleni
    • 1
  • Lorella Fanti
    • 1
  1. 1.IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Division of Gastroenterology and Gastrointestinal EndoscopyMilano (MI)Italy

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