Munyaradzi Chimukangara, MD1, Anahita D Jalilvand, MD1, W. Scott Melvin, MD2, Kyle A Perry, MD1. 1Department of Surgery, The Ohio State University, 2Department of Surgery, Albert Einstein College of Medicine
INTRODUCTION: 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 antacid medication use.
METHODS AND PROCEDURES: We performed a review of all patients undergoing TIF at the Ohio State University Wexner Medical Center for objectively confirmed GERD between 2007 and 2014. Reflux symptoms and quality of life were assessed using the Gastroesophageal Reflux Disease Health-Related Quality of Life (GERD-HRQL) questionnaire. Baseline data were collected in the clinic setting. Follow-up data were obtained by telephone questionnaire in the short-term (6 [2-19] months), and long-term (98 [48-120] months). Complete long-term follow-up data were available for 23 patients who had not undergone a subsequent antireflux procedure. Data are presented as incidence (%), mean ± SD, or median (range) as appropriate, and a p-value of <0.05 was considered statistically significant.
RESULTS: Fifty-seven patients with a median age of 46 (18-73) years and an average BMI of 28.8 ± 4.9 kg/m2 underwent TIF during the study period. Forty percent of the patients were female, and they had a median GERD-HRQL score of 24 (8-40) while taking a proton pump inhibitor (PPI) at least daily. TIF was completed successfully in all patients. At short-term follow-up, median GERD-HRQL score decreased to 6.5 (0-34, p<0.01) and 55% successfully stopped using daily PPI. Sixty-five percent of patients expressed satisfaction with their medical condition. At long-term follow-up, 12 patients had undergone subsequent antireflux surgery and were excluded from the analysis. Of the 23 patients with long-term follow-up of a primary TIF without subsequent intervention, 73% reported daily acid reducing medication use, and the median GERD-HRQL score was 9 (1-21, p<0.01). Seventy-eight percent of these patients expressed satisfaction with their condition.
CONCLUSIONS: This study demonstrates that TIF can produce durable improvements in disease-specific quality of life in select patients with symptomatic GERD. While the majority of patients in this series required some acid reducing medications in the long-term, a significant subset of patients did achieve significant long-term improvement in disease-specific quality of life and satisfaction with their medical condition. Further studies are required to identify the specific patient population who may benefit from this procedure to avoid the need for subsequent antireflux surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87393
Program Number: S117
Presentation Session: Residents/Fellows Session
Presentation Type: ResFel
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