The transoral incisionless fundoplication is a minimally invasive treatment for gastroesophageal reflux disease (GERD) that is performed in the outpatient setting. The TIF procedure is performed from inside the patient’s stomach without incisions. This procedure delivers patient outcomes similar to those provided by conventional ARS procedures, but is less invasive, has fewer adverse effects, and does not limit future treatment options. Following the principles of ARS, the TIF procedure repairs the anti-reflux barrier by reducing a hiatal hernia (≤ 2 cm), and creating a valve 2 to 4 cm in length and greater than 270 degree circumferential wrap, thus restoring the dynamics of the angle of His.
A Less Invasive Approach to Fundoplication
Fundoplication procedures have been used to effectively treat patients with GERD for over 50 years. The TIF procedure differs from a traditional fundoplication procedure because it is performed through the mouth rather than through laparoscopy or open abdominal incisions.
During a TIF procedure, the patient is placed under general anesthesia so that the EsophyX device, used with a flexible endoscope, can be gently introduced into the stomach under constant visualization. The endoscope and the device are retroflexed and a helical retractor is engaged into the tissue slightly distal to the Z line. The fundus of the stomach is folded up and around the distal esophagus utilizing the tissue mold and chassis of the device. After locking all the tissue manipulating elements, an integrated suction apparatus is activated to gently grasp the distal esophagus and position it in the abdominal cavity distal to the diaphragm. H-shaped Serosa Fuse fasteners, made of polypropylene with strength equivalent to 3-0 sutures, are then delivered through apposed layers of esophageal and fundus tissue to anchor the repair. This process is repeated to create a full thickness, partial circumference, gastroesophageal fundoplication. Approximately 20 fasteners are implanted during the procedure to create fusion of the esophageal and fundus tissues and form the valve
TIF is a good solution for adults with moderate-to-severe GERD who experience heartburn symptoms even while on daily medications. You may not need this procedure if your symptoms are controlled by making lifestyle changes or following instructed use of proton pump inhibitors (PPIs).
There are many benefits to this procedure, including controlling disruptive symptoms and getting off daily heartburn medicine. The TIF procedure is cleared by the FDA and is covered by most insurance companies. Since it is an endoscopic procedure and minimally invasive, it leaves no incisions. This means that there are no metal implants and no gas or bloating following.
Since your physician will be working in your esophagus and stomach, it is important not to eat or drink anything for several hours before the exam. Your physician will give you instructions about the use of regular medications, including blood thinners, before the exam. Because of the mild sedation, you are not allowed to drive, operate heavy machinery or make any important decisions immediately following the exam. It’s important to have someone with you to drive you home.
The TIF procedure takes about 45-60 minutes.
Most patients can return home the same or following day and resume most ordinary activities within a few days. Patients should expect to experience some minor discomfort following the procedure – sore throat, hoarseness, nausea, difficulty swallowing – but these are all temporary.
Your physician will recommend following a modified diet for several weeks post-procedure. This modified diet will contain phases of graduating texture – clear liquids, full liquids, soft food – introducing each new texture on a schedule. It’s important to follow this diet closely to ensure the new valve heals properly.
The TIF procedure is extremely safe, and there have been no reports of major complications.
Many clinical studies have shown that when patients adhere to the recommended post-procedure diet the TIF procedure is considered to be a long-lasting treatment for chronic acid reflux.