Transoral Incisionless Fundoplication for Refractory GERD: A community practice experience

Aliu Sanni, MD¹, Ifeoma Oriala, BS², Phillip Yun, BA³, Mateo Guarderas, BS⁴, Christian Cruz, MD¹, Angel Farinas, MD¹, Angelina Postoev, MD¹, Christopher Ibikunle, MD, FACS¹. ¹Georgia Surgicare / University of Georgia, ²International American University, ³GRU/UGA Medical Partnership, ⁴Universidad San Francisco de Quito

Introduction

Adequate control of refractory regurgitation and esophageal manifestations experienced by chronic gastroesophageal reflux disease (GERD) patients on long term Proton Pump Inhibitors (PPI) has remained a major therapeutic concern.

Several prospective and retrospective studies have supported the use of Transoral Incisionless Fundoplication (TIF) performed with the EsophyX device as a method of treating these symptoms and potentially eliminating patient's dependence on PPIs.

The aim of this study was to review the efficacy and outcome of TIF treatment of symptomatic patients at our facility.

Methods

Patients with refractory GERD symptoms following long term PPI treatment and small hiatal hernias (<3cm) diagnosed on endoscopy were enrolled onto this study between January 2012 and December 2013. The TIF procedure was performed using established protocols. Subjective and objective outcomes were evaluated with the GERD-Health Related Quality of Life (GERD-HRQL), Reflux Symptom Index (RSI) and patient satisfaction questionnaires before and after the procedure. The competency of the fundoplication was evaluated by endoscopy. Statistical analysis was performed by using the student t-test for continuous data with a p-value < 0.05 determined as statistically significant.

Results

A total of 44 patients underwent the TIF procedure in this time frame. The mean age and BMI were 57 years & 30.3kg/m2 respectively. 31 of 44 patients (70%) were female. There were no peri-operative complications reported . Objective symptoms using the GERD-HRQL( 17.5 vs. 6.6; p<0.05) and RSI scores (20.1 vs. 8.42; p<0.05) were significantly improved following the TIF procedure. At a median follow up of 6 months ( range=4-18), up to 42 patients (95.5%) reported partial or complete resolution of their primary symptoms. 80% of the patients were satisfied with the overall outcome of the procedure.

Conclusion

Among selected patients with refractory GERD symptoms with a small hiatal hernia, TIF performed using the Esophyx device provides complete symptom relief in the majority of patients.