Concomitant Transoral Incisionless Fundoplication Improves Symptoms of Gastroesophageal Reflux Disease

Bile Reflux and GERD
GERD, Gastroesophageal Reflux Disease
Researchers evaluated the efficacy, safety, and feasibility of concomitant transoral incisionless fundoplication to reduce symptoms of heartburn, regurgitation, and reflux.

Concomitant transoral incisionless fundoplication (cTIF) was found to be safe and efficacious for reducing symptoms of gastroesophageal reflux disease (GERD). These findings, from researchers at the University of California, Irvine Medical Center, were published in the Journal of the American College of Surgeons.

The study included all patients (N=60) with clinically significant GERD who underwent cTIF between 2018 and 2020 at a single center. During laparoscopic procedures, hiatal hernias were repaired, and a diagnostic upper endoscopy was performed, followed by an interventional endoscopic TIF. The investigators assessed patients by using the Reflux Disease Questionnaire (RDQ), GERD Health-Related Quality of Life (GERD-HRQL), and Reflux Symptom Index (RSI).

Patients were aged 59.3 years (range, 27-77), 53.3% were men, average body mass index was 30 kg/m2 (range, 19.8-36), and mean hiatal hernia measurement was 2.9±1.5 cm. At baseline, 51.7% of patients had esophagitis and 31.7% had Barrett esophagus.

Technical success was determined for 100% of the procedures. The mean number of plications using TIF was 16.8±3.4, operations lasted for a duration of 1.6±0.7 hours, and hospital duration was 1.4±0.8 days.

A single patient had an intraprocedural esophageal mucosal tear. In the 24 hours after the procedures, 1 patient had an upper gastrointestinal bleed; 1 patient developed thrush, fever, and syncope; and 2 patients were readmitted to the hospital for bloating and delayed gastric emptying, respectively.

At follow-up, the researchers observed significant improvements of GERD symptoms. Mean RDQ scores for frequency and severity were 17.4 and 16.7 at baseline and decreased to 4.78 (P <.01) and 4.56 (P <.01) at 12 months, respectively.

Compared with baseline, at 12 months symptoms of heartburn (GERD-HRQL: 23.26 vs 7.37; P <.01), regurgitation (GERD-HRQL: 14.26 vs 0; P <.01), and reflux (RSI: 17.67 vs 8.1; P =.013) were found to be significantly improved.

Use of proton pump inhibitors was reduced at 12 months compared with baseline (68.3% vs 14.3%), and H2 blocker use was increased (8.3% vs 28.6%).

This study was limited by the low preprocedural and postprocedural response rate to the RDQ, GERD-HRQL, and RSI (<50%) questionnaires because of patients skipping or missing sections when completing their assessments.

These data indicate this novel interdisciplinary approach to GERD therapy, cTIF, successfully reduced symptoms of heartburn, regurgitation, and reflux, with an acceptable safety profile.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Choi AY, Roccato MK, Samarasena JB, et al. Novel interdisciplinary approach to GERD: concomitant laparoscopic hiatal hernia repair with transoral incisionless fundoplication. Published online December 17, 2021. doi:10.1016/j.jamcollsurg.2020.11.021