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Surgical Endoscopy

, Volume 33, Issue 4, pp 1304–1309 | Cite as

Long-term reported outcomes of transoral incisionless fundoplication: an 8-year cohort study

  • Munyaradzi Chimukangara
  • Anahita D. Jalilvand
  • W. Scott Melvin
  • Kyle A. PerryEmail author
2018 SAGES Oral
  • 205 Downloads

Abstract

Background

Transoral incisionless fundoplication (TIF) offers an endoscopic approach to the treatment of gastroesophageal reflux disease (GERD). Controlled trials have demonstrated the short-term efficacy of this procedure, but long-term follow-up studies are lacking. The objective of this study was to evaluate the long-term impact of TIF on disease-specific quality of life and antisecretory medication use.

Methods

We performed retrospective cohort study of all patients undergoing TIF between 2007 and 2014 in a large academic medical center. Reflux symptoms and quality of life were assessed using the gastroesophageal reflux disease health-related quality of life (GERD-HRQL) questionnaire at baseline, short-term, and long-term follow-up.

Results

Fifty-seven patients with a median age of 46 (37–59) years and an average BMI of 28.8 ± 4.9 kg/m2 underwent TIF during the study period. Sixty percent of the patients were female, and all were taking a PPI at least daily. At a median follow-up interval of 97 months, twelve patients had undergone subsequent laparoscopic antireflux surgery (LARS). Of those who had not, 23 had complete long-term follow-up data for analysis and were included in the study. Seventy-three percent reported daily acid-reducing medication use, and the median GERD-HRQL score was 10 (6–14) compared to 24 (15–28) at baseline (p < 0.01). Seventy-eight percent of these patients expressed satisfaction or neutral feelings about their GERD management. There were no significant differences in the baseline characteristics of patients who underwent LARS during the study period and those who did not.

Conclusions

This study demonstrates that TIF can produce durable improvements in disease-specific quality of life in some patients with symptomatic GERD. The majority of patients resumed daily PPI therapy during the study period, but with significantly improved GERD-HRQL scores compared to baseline and increased satisfaction with their medical condition.

Keywords

Transoral incisionless fundoplication GERD Long-term outcomes 

Notes

Acknowledgements

The authors were supported, in part, by the Foundation for Surgical Fellowships (MC).

Compliance with ethical standards

Disclosures

Munyaradzi Chimukangara, Anahita D. Jalilvand, W. Scott Melvin, and Kyle A. Perry declare no conflicts of interests.

References

  1. 1.
    Trad KS, Fox MA, Simoni G, Shughoury AB, Mavrelis PG, Raza M, Heise JA, Barnes WE (2017) Transoral fundoplication offers durable symptom control for chronic GERD: 3-year report from the TEMPO randomized trial with a crossover arm. Surg Endosc 31:2498–2508.  https://doi.org/10.1007/s00464-016-5252-8 CrossRefGoogle Scholar
  2. 2.
    Hopkins J, Switzer NJ, Karmali S (2015) Update on novel endoscopic therapies to treat gastroesophageal reflex disease: a review. World J Gastrointest Endosc 7(11):1039–1044.  https://doi.org/10.4253/wjge.v7.i11.1039 CrossRefGoogle Scholar
  3. 3.
    Kethman W, Hawn M (2017) New approaches to gastroesophageal reflux disease. J Gastrointest Surg 21(9):1544–1552.  https://doi.org/10.1007/s11605-017-3439-5 CrossRefGoogle Scholar
  4. 4.
    Huang X, Chen S, Zhao H, Zeng X, Lian J, Tseng Y, Chen J (2017) Efficacy of transoral incisionless fundoplication (TIF) for the treatment of GERD: a systematic review with meta-analysis. Surg Endosc 31:1032–1044.  https://doi.org/10.1007/s00464-016-5111-7 CrossRefGoogle Scholar
  5. 5.
    Moraes-Filho JP (2012) Refractory gastroesophageal reflux disease. Arq Gastroenterol 49(4):296–301.  https://doi.org/10.1590/s0004-28032012000400012 CrossRefGoogle Scholar
  6. 6.
    Kahrilas PJ, Howden CW, Hughes N (2011) Response of regurgitation to proton pump inhibitor therapy in clinical trials of gastroesophageal reflux disease. Am J Gastroenterol 106(8):1419–1425.  https://doi.org/10.1038/ajg.2011.146 CrossRefGoogle Scholar
  7. 7.
    Gerson LB, Boparai V, Ullah N, Triadafilopoulos G (2004) Oesophageal and gastric pH profiles in patients with gastro-oesophageal reflux disease and Barrett’s oesophagus treated with proton pump inhibitors. Aliment Pharmacol Ther 20(6):637–643.  https://doi.org/10.1111/j.1365-2036.2004.02127.x CrossRefGoogle Scholar
  8. 8.
    Sheen E, Triadafilopoulos G (2011) Adverse effects of long-term proton pump inhibitor therapy. Dig Dis Sci 56(4):931–950.  https://doi.org/10.1007/s10620-010-1560-3 CrossRefGoogle Scholar
  9. 9.
    Hunter JG, Trus TL, Branum GD, Waring JP, Wood WC (1996) A physiologic approach to laparoscopic fundoplication for gastroesophageal reflux disease. Ann Surg 223(6):673–687CrossRefGoogle Scholar
  10. 10.
    Testoni PA, Mazzoleni G, Testoni SG (2016) Transoral incisionless fundoplication for gastro-esophageal reflux disease: techniques and outcomes. World J Gastrointest Pharmacol Ther 7:179–189.  https://doi.org/10.4292/wjgpt.v7.i2.179 CrossRefGoogle Scholar
  11. 11.
    Trad KS (2016) Transoral incisionless fundoplication: current status. Curr Opin Gastroenterol 32:338–343CrossRefGoogle Scholar
  12. 12.
    Bergman S, Mikami J et al (2008) Endoluminal fundoplication with EsophyX: the initial North American Experience. Surg Innov 15(3):166–170CrossRefGoogle Scholar
  13. 13.
    Hunter JG, 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 (2015) Efficacy of transoral fundoplication vs omeprazole for treatment of regurgitation in a randomized controlled trial. Gastroenterology 148:324–333.  https://doi.org/10.1053/j.gastro.2014.10.009 CrossRefGoogle Scholar
  14. 14.
    Stefanidis G, Viazis N, Kotsikoros N, Tsoukalas N, Lala E, Theocharis L, Fassaris A, Manolakopoulos (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.  https://doi.org/10.1111/dote.12525 Google Scholar
  15. 15.
    Testoni PA, Testoni S, Mazzoleni G, Vailati C, Passaretti S (2015) Long-term efficacy of transoral incisionless 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.  https://doi.org/10.1007/s00464-014-4008-6 CrossRefGoogle Scholar
  16. 16.
    Broeders JA, Draaisma WA, Bredenoord AJ, Smout AJ, Broeders IA, Gooszen HG (2010) Long-term outcome of Nissen fundoplication in non-erosive and erosive gastro-oesophageal reflux disease. Br J Surg 97(6):845–852.  https://doi.org/10.1002/bjs.7023 CrossRefGoogle Scholar
  17. 17.
    Grover BT, Kothari SN (2015) Reoperative antireflux surgery. Surg Clin North Am 95(3):629–640.  https://doi.org/10.1016/j.suc.2015.02.014 CrossRefGoogle Scholar
  18. 18.
    Funk LM, Zhang JY, Drosdeck JM, Melvin WS, Walker JP, Perry KA (2015) Long-term cost-effectiveness of medical, endoscopic and surgical management of gastroesophageal reflux disease. Surgery 157(1):126–136.  https://doi.org/10.1016/j.surg.2014.05.027 CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of SurgeryThe Ohio State UniversityColumbusUSA
  2. 2.Department of SurgeryAlbert Einstein College of MedicineBronxUSA
  3. 3.Division of General & Gastrointestinal SurgeryColumbusUSA

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