Background and Aims
Transoral incisionless fundoplication (TIF) using the EsophyX device (EndoGastric
Solutions, Inc, Redmond, Wash, USA) is a minimally invasive endoscopic fundoplication
technique. Our study aimed to assess the efficacy of TIF for atypical GERD symptoms
in patients with chronic or refractory GERD.
Methods
A systematic search of 4 major databases was performed. All original studies assessing
atypical GERD using a validated symptom questionnaire (the reflux symptom index [RSI])
were included. The RSI score was assessed before and after TIF at a 6- and 12-month
follow-up. Data on technical success rate, adverse events, proton pump inhibitor (PPI)
use, and patient satisfaction were also collected. Only TIF procedures currently in
practice using the EsophyX device (ie, TIF 2.0) and TIF with concomitant hiatal hernia
repair were included in the review.
Results
Ten studies (564 patients) were included. At the 6- and 12- month follow-up, there
was a mean reduction of 15.72 (95% confidence interval, 12.15-19.29) and 14.73 (95%
confidence interval, 11.74-17.72) points, respectively, in the RSI score post-TIF,
with a technical success rate of 99.5% and a pooled adverse event rate of 1%. At both
time intervals, more than two-thirds of the patients were satisfied with their health
condition and roughly three-fourths of the patients were off daily PPIs.
Conclusions
Our study shows that TIF using the EsophyX device is safe and effective in reducing
atypical GERD symptoms at 6 and 12 months of follow-up. It improves patient-centered
outcomes and can be a minimally invasive therapeutic option for patients suffering
from atypical GERD symptoms on chronic medical therapy.
Graphical abstract
Graphical Abstract
Abbreviations:
CI (confidence interval), cTIF (transoral incisionless fundoplication with concomitant hiatal hernia repair), PPI (proton pump inhibitor), RSI (reflux symptom index), TIF (transoral incisionless fundoplication)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: November 16, 2022
Accepted:
November 7,
2022
Received:
June 28,
2022
Footnotes
DISCLOSURE: The following authors disclosed financial relationships: P. Jirapinyo: Research support from Apollo Endosurgery, Boston Scientific, Fractyl, GI Dynamics, USGI Medical; consultant for Erbe, Endogastric Solutions, and Spatz. C. C. Thompson: Consultant for Apollo Endosurgery, Boston Scientific, Covidien/Medtronic, Enterasense Ltd, Envision Endoscopy, Fractyl, GI Dynamics, GI Windows, Olympus, USGI Medical, Fujifilm, and Lumendi; research support from Apollo Endosurgery, Aspire Bariatrics, Boston Scientific, Erbe, GI Dynamics, Olympus, USGI Medical, Fujifilm, and Lumendi; general partner for BlueFlame Healthcare Venture Fund; founder and board member for Envision Endoscopy, Enterasense Ltd, and GI Windows; advisory board for Fractyl and USGI Medical. All other authors disclosed no financial relationships.
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