Transoral incisionless fundoplication

Transoral incisionless fundoplication (TIF) is a minimally invasive endoscopic procedure developed to treat symptoms of gastroesophageal reflux disease (GERD). It is designed to recreate the valve between the esophagus and the stomach to reduce or prevent acid reflux, mimicking the mechanism of a Nissen fundoplication without the need for abdominal incisions.

Overview

The TIF procedure is performed using a specialized device known as the EsophyX, which is introduced through the mouth, passed down the pharynx and esophagus, and into the stomach. An endoscope provides visualization during the procedure. Using this approach, the upper part of the stomach is folded and fastened around the lower esophageal sphincter to create a valve that reduces acid reflux. This technique avoids external incisions and does not involve dissection of the abdominal wall, as in traditional laparoscopic surgery.

Indications

TIF is indicated in individuals with:

• Chronic gastroesophageal reflux disease
• Incomplete symptom control with proton pump inhibitors (PPIs)
• Intolerance or reluctance to use long-term medications
• Small or absent hiatal hernia (typically <2 cm)

Procedure

The TIF procedure is typically performed under general anesthesia and takes about 30–60 minutes. It is considered an outpatient procedure, allowing most patients to return home the same day. The EsophyX device is used to place multiple fasteners in the gastric fundus to wrap the tissue around the lower esophagus. This restores the natural anti-reflux barrier.

In some patients with a significant hiatal hernia, a concurrent or prior hiatal hernia repair may be necessary. Studies suggest that a minority of individuals undergoing TIF may later require surgical repair of a hernia if symptoms persist or worsen.

Effectiveness

Clinical studies have demonstrated that TIF may effectively reduce GERD symptoms, improve quality of life, and reduce dependency on acid-suppressive medications. Some key points:

• Symptom relief may last up to **six years** following the procedure.
• TIF is most effective in patients with mild to moderate GERD.
• Many patients report reduced need for daily PPI use.

Complications

TIF is generally considered safe, but like all procedures, it carries risks. Complications occur in about **1 in 30** patients. These may include:

• Esophageal perforation
• Bleeding
• Sore throat or dysphagia (difficulty swallowing)
• Pneumothorax (rare)

Postoperative discomfort is typically mild and short-lived. Dietary modification and activity restrictions are usually advised for a few weeks post-procedure.

Advantages

• No abdominal incisions
• Less postoperative pain
• Shorter recovery time
• Preserves anatomy
• Suitable for patients unfit for laparoscopic surgery

Limitations

• Not suitable for large hiatal hernias
• Limited long-term data beyond 6 years
• Some patients may require repeat procedures or subsequent fundoplication

See also

• Gastroesophageal reflux disease
• Nissen fundoplication
• Endoscopy
• Hiatal hernia
• Esophagus

External links

• Clinical outcomes of transoral incisionless fundoplication (NCBI)
• U.S. FDA approval summary for the EsophyX device