Efficacy and Safety of Trans—Oral Incisionless Fundoplication Performed by Gastroenterologists

Raza, Ali; Catalano, Marc F.; Rahimi, Erik; Zamil, Hani; Kannadath, Bijun S.; Guider, Julie; Chokshi, Reena V.; Cash, Brooks D.; Wilson, Todd; Wilson, Erik B.; Thosani, Nirav

doi:10.14309/00000434-201810001-01221

Cited by 2 publications

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“…In a preliminary report, Raza et al suggested that TIF could be safely performed by trained therapeutic endoscopists in the endoscopy suite with no intra-procedure or post-procedure adverse events 17 . Also, it showed that all patients could safely be discharged within 24 hours post-procedure 19 . Similarly, our study suggests that TIF can be performed safely and successfully by an experienced gastroenterologist in the endoscopy unit after a standardized didactic and observational experience.…”

Section: Discussionmentioning

confidence: 90%

The learning curve for transoral incisionless fundoplication

et al. 2021

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Background and study aims Transoral incisionless fundoplication (TIF) is a safe and effective minimally invasive endoscopic technique for treating gastroesophageal reflux disease (GERD). The learning curve for this technique has not been reported. We studied the learning curve for TIF when performed by a gastroenterologist by identifying the threshold number of procedures needed to achieve consistent technical success or proficiency (consistent creation of TIF valve ≥ 270 degrees in circumference, ≥ 2 cm long) and efficiency after didactic, hands-on and case observation experience. Patients and methods We analyzed prospectively collected data from patients who had TIF performed by a single therapeutic endoscopist within 17 months after basic training. We determined thresholds for procedural learning using cumulative sum of means (CUSUM) analysis to detect changes in achievement rates over time. We used breakpoint analysis to calculate procedure metrics related to proficiency and efficiency. Results A total of 69 patients had 72 TIFs. The most common indications were refractory GERD (44.7 %) and proton pump inhbitor intolerance (23.6 %). Proficiency was achieved at the 18th to 20th procedure. The maximum efficiency for performing a plication was achieved after the 26th procedure, when mean time per plication decreased to 2.7 from 5.1 minutes (P < 0.0001). TIF procedures time varied until the 44th procedure, after which it decreased significantly from 53.7 minutes to 39.4 minutes (P < 0.0001). Conclusions TIF can be safely, successfully, and efficiently performed in the endoscopy suite by a therapeutic endoscopist. The TIF learning curve is steep but proficiency can be achieved after a basic training experience and 18 to 20 independently performed procedures.

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Section: Discussionmentioning

confidence: 90%

The learning curve for transoral incisionless fundoplication

et al. 2021

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“…In the MSA cohort, six studies 26 29 30 40 41 42 were prospective and three 22 43 44 were retrospective, whereas in the TIF2 cohort, 11 studies were prospective 23 25 27 28 31 45 46 47 48 49 50 and four were retrospective 24 51 52 53 . There were no TIF or MSA studies based on population data.…”

Section: Resultsmentioning

confidence: 99%

“…There were no TIF or MSA studies based on population data. Based on the New-Castle Ottawa scoring system, all nine MSA studies 22 26 29 30 40 41 42 43 44 were considered to be of high quality, 12 TIF studies were of high quality, and three TIF studies 46 49 51 were of medium quality. There were no low-quality studies.…”

Section: Resultsmentioning

confidence: 99%

Clinical efficacy and safety of magnetic sphincter augmentation (MSA) and transoral incisionless fundoplication (TIF2) in refractory gastroesophageal reflux disease (GERD): a systematic review and meta-analysis

et al. 2021

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Background and study aims Proton pump inhibitors (PPI) are effective medical therapy options for gastro-esophageal reflux disease (GERD). However, 20 % to 40 % of patients report symptoms despite taking daily PPI. Transoral incisionless fundoplication (TIF2) and magnetic sphincter augmentation (MSA) are less invasive options for the treatment of refractory GERD and are increasingly gaining popularity. Methods We conducted a comprehensive search of several databases to identify relevant studies. Our primary aim was to compare the efficacy of both interventions reported as improvement in Gastroesophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL) score, overall patient satisfaction, improvement in post-procedure regurgitation, and fraction of patients completely off PPI therapy at follow up. Results Twenty-four studies with 1942 patients were included in the final analysis. Both MSA and TIF2 had comparable technical success and clinical success based on improvement in GERD-HRQL scores i. e. 98.8 % (CI 95.6,99.7) vs 98.5 % (CI 95.7,99.5) and 80.4 % (CI 66,89.6) vs 77.7 % (CI 64.1,87.2), respectively. A significantly greater proportion of patients reported improvement in regurgitation, i. e. 91.1 % (CI 83.8,95.3) vs 73.1 % (CI 62.5,81.7) and were able to completely discontinue PPI therapy with MSA compared to TIF2 i. e. 91.3 % (CI 81.5,96.2) vs 63.8 % (CI 51.6,74.4). Patients’ BMI and presence of a hiatal hernia did not have any effect on procedural outcomes. Conclusion Both procedures performed at par when comparing clinical success in terms of improvement in GERD-HRQL scores. In terms of overall patient satisfaction, post procedure regurgitation and cumulative number of patients off PPI therapy, MSA outperforms TIF2.

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Efficacy and Safety of Trans—Oral Incisionless Fundoplication Performed by Gastroenterologists

Cited by 2 publications

References 0 publications

The learning curve for transoral incisionless fundoplication

The learning curve for transoral incisionless fundoplication

Clinical efficacy and safety of magnetic sphincter augmentation (MSA) and transoral incisionless fundoplication (TIF2) in refractory gastroesophageal reflux disease (GERD): a systematic review and meta-analysis

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