Transoral Insicionless Fundoplication for the Treatment of Gerd: 12 Months Results

Camilo Boza, MD, Diego Barros, MD, Tomas Zamora, Andrea Vega, RN, Fernando Pimentel, MD, Napoleon Salgado, MD, Luis Ibanez, MD, Nicolas Jarufe, MD, Allan Sharp, MD

Pontificia Universidad Catolica de Chile

Background: Given the high prevalence of gastroesophageal reflux disease (GERD), the transoral incisionless fundoplication (TIF) is presented as an attractive alternative to traditional surgical treatment, offering a minimally invasive option for patients refractory to medical treatment or those who do not want to depend on drug use on a permanent basis.

Methods: Prospective study conducted at the Pontificia Universidad Católica de Chile´s Clinical Hospital during the years 2008 – 2010. Inclusion criteria were patients between 18 and 75 years old with GERD diagnosis and complete preoperative study including upper GI endoscopy, esophageal manometry, 24 hours pH monitoring, and symptomatic gastroesophageal reflux defined by a GERD-HRLQ score >20. All patients were on long-term treatment for GERD with proton pump inhibitors (PPI). The TIF was performed under general anesthesia using the EsophyX device (Endogastric Solutions, Redmond, WA, USA) creating an anterior partial fundoplication of 270 degrees. Patients were followed at 12 months post surgery and suspension of PPI was prescribed.

Results: Twenty four patients were included during the studied period; all surgeries were performed without any incidents or complications and patients were discharged from hospital 1 day after the procedure. Postoperative GERD-HRQL scores decreased significantly by a median of 77% (p<0,001). Nineteen (79%) patients expressed that they were satisfied with the procedure.
During early postoperative period, 21 (91%) patients with manifestations of regurgitation reported elimination of their symptoms, as well as did 23 (100%) of those patients with atypical symptoms. Only 48% of patients experienced occasional heartburn. Twenty one (88%) patients reduced PPI intake.
Twenty four hour esophageal pH-metry demonstrated that the mean total time with Acid Reflux decreased significantly by 53 % (13.8 v/s 7.13% p<0.017).

Conclusions: The TIF procedure using the EsophyX device is feasible and safe treatment for Gastroesophageal Reflux Disease with a lower rate of complications than the classic surgical management. There is a significant improvement in the quality of life, symptoms, use of PPI and 24 hours pH-metry values. Longer follow-up is required to determine maintenance of these results in the long-term.

Session: Poster Presentation

Program Number: P670

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