Transoral Incisionless Fundoplication May Prove Effective for GERD

Transoral incisionless fundoplication (TIF) provides safe and durable antireflux therapy in a canine model, according to a report in the July Annals of Surgery.
"TIF is safe and reproduces many of the critical components of the gold standard operation, laparoscopic Nissen fundoplication," Dr. Blair A. Jobe from the University of Pittsburgh told Reuters Health.

In studies involving 42 dogs, Dr. Jobe and colleagues found that all fasteners used in TIF were intact at autopsy up to one year after the procedure, with no evidence of fracture, stretching, or dissolution. Cardia circumference and Hill valve classification significantly improved after TIF, and resting lower esophageal sphincter pressure increased significantly from baseline.

TIF also decreased the number of extended reflux episodes, the researchers note.

There were no significant adverse events associated with the procedure, the investigators say.

"Because it is an incisionless and outpatient procedure, TIF opens the door to an anatomic reconstruction to the entire spectrum of patients with GERD," Dr. Jobe said. "In this vein, we are currently performing a randomized controlled trial that compares transoral incisionless fundoplication to proton pump inhibitor therapy with the primary endpoint of long-term symptom amelioration."

"The optimal patient for a TIF procedure would include those with little or no hiatal hernia, dependence on antisecretory medication, and symptom correlation on pH testing," Dr. Jobe added.

Ann Surg 2008;248:69-76.

Reviewed by Ramaz Mitaishvili, MD

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