Transoral incisionless fundoplication with Medigus ultrasonic surgical endostapler (MUSE) for the treatment of gastro-esophageal reflux disease: outcomes up to 3 years

Testoni, Sabrina Gloria Giulia; Cilona, Maria Bernadette; Mazzoleni, Giorgia; Fanti, Lorella; Ribichini, Emanuela; Cavestro, Giulia Martina; Esposito, Dario; Viale, Edi; Notaristefano, Chiara; Zuppardo, Raffaella Alessia; Azzolini, Francesco; Passaretti, Sandro; Testoni, Pier Alberto

doi:10.1007/s00464-021-08860-w

Cited by 4 publications

(2 citation statements)

References 21 publications

(31 reference statements)

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“…Moreover, Testoni et al performed transoral incisionless fundoplication reporting a significant improvement of symptoms and PPI consumption after 3 years of follow-up, but more than 30% of patients presented persistent esophagitis at 1 year [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Robotic revision surgery after failed Nissen anti-reflux surgery: a single center experience and a literature review

et al. 2023

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Background The gastroesophageal reflux disease (GERD) worldwide prevalence is increasing maybe due to population aging and the obesity epidemic. Nissen fundoplication is the most common surgical procedure for GERD with a failure rate of approximately 20% which might require a redo surgery. The aim of this study was to evaluate the short- and long-term outcomes of robotic redo procedures after anti-reflux surgery failure including a narrative review. Methods We reviewed our 15-year experience from 2005 to 2020 including 317 procedures, 306 for primary, and 11 for revisional surgery. Results Patients included in the redo series underwent primary Nissen fundoplication with a mean age of 57.6 years (range, 43–71). All procedures were minimally invasive and no conversion to open surgery was registered. The meshes were used in five (45.45%) patients. The mean operative time was 147 min (range, 110–225) and the mean hospital stay was 3.2 days (range, 2–7). At a mean follow-up of 78 months (range, 18–192), one patient suffered for persistent dysphagia and one for delayed gastric emptying. We had two (18.19%) Clavien–Dindo grade IIIa complications, consisting of postoperative pneumothoraxes treated with chest drainage. Conclusion Redo anti-reflux surgery is indicated in selected patients and the robotic approach is safe when it is performed in specialized centers, considering its surgical technical difficulty.

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Section: Discussionmentioning

confidence: 99%

Robotic revision surgery after failed Nissen anti-reflux surgery: a single center experience and a literature review

et al. 2023

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“…Two severe adverse events requiring intervention occurred in the first 24 operations [16], and no new Serious Adverse Event (SAE) was reported after 6 months of follow-up. In another study, PPI consumption was stopped and halved in 38/42(90.5%), 31/35(88.6%), and 27/31(81.7%) of cases at 1, 2, and 3 years post-procedure, respectively [17]. GERD-HRQL decreased at least 50%, respectively, in 30/42 (71.5%), 25/35 (71.4%), and 21/31 (67.7%) of cases.…”

Section: Discussionmentioning

confidence: 99%

The long-term efficacy of transoral incisionless fundoplication with Medigus Ultrasonic Surgical Endostapler (MUSE) for gastroesophageal reflux disease

Shen

Guo

et al. 2023

Esophagus

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Background To evaluate the long-term efficacy of transoral incisionless fundoplication (TIF) with Medigus Ultrasonic Surgical Endostapler (MUSE) for gastroesophageal reflux disease (GERD). Methods A total of 16 patients with proton pump inhibitor-dependent gastroesophageal reflux disease had undergone TIF by MUSE in Shanghai General Hospital （Shanghai, China）from March 2017 to December 2018. Patients were followed up at 6 months, and the GERD-health-related quality of life (GERD-HRQL) questionnaire score, the GERD questionnaire (GERD-Q) score, high-resolution esophageal manometry (HREM) and 24 h esophageal pH parameters, the Hill grade of the gastroesophageal flap valve (GEFV) and daily Proton pump inhibitor (PPI) consumption before and after procedure were compared. Patients also were followed up at 3 years and 5 years using a structured questionnaire via phone which evaluated symptoms of reflux, dose of PPI medication and side effects. Results Follow-up data were collected from 13 patients, ranging from 38 to 63 months, 53 months on average. 10/13 patients reported symptomatic improvement and daily PPI consumption was stopped or halved in 11/13. After procedure, the mean scores of GERD-HRQL and GERD-Q were significantly increased. The mean DeMeester score, the mean acid exposure time percentage and the mean number of acid reflux episodes were significantly lower. The mean rest pressure at lower esophageal sphincter (LES) had no significant difference. Conclusion TIF by MUSE has significant efficacy in the treatment of PPI-dependent GERD, which can improve symptoms and life quality of patients, and reduce the acid exposure time for long-term. Chictr.org.cn. Trial Registration ChiCTR2000034350.

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Comparison of EsophyX2.0 and MUSE systems for transoral incisionless fundoplication: Technical aspects and outcomes up to 3 years

Testoni,

Pantaleo,

Contu

et al. 2024

Digestive Endoscopy

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ObjectivesWe compared the efficacy and safety of transoral incisionless fundoplication (TIF) with the EsophyX2.0 and MUSE systems for treatment of gastroesophageal reflux disease (GERD).MethodsTIF outcomes from prospective protocols (Esophy2.0X: 2007–2012; MUSE: 2015–2019) were retrospectively compared regarding technical success, moderate/severe adverse events, morpho‐functional findings up to 1 year, and clinical outcomes up to 3 years. Inclusion criteria were: (i) at least 6‐month symptomatic GERD, full/partial response to proton pump inhibitors (PPI), esophagitis, and nonerosive reflux disease/hypersensitive esophagus (both protocols); (ii) hiatal hernia <3 cm (Esophy2.0X) and ≤2.5 cm (MUSE); and (iii) Barrett's esophagus <3 cm (MUSE).ResultsIn the 50 EsophyX2.0 and 46 MUSE procedures, technical success and adverse event rates were similar, but MUSE‐related adverse events (4.4%) were life‐threatening. At 12 months, hiatal hernia recurred more frequently after EsophyX2.0 (P = 0.008). At 6 months, significantly fewer total and acid refluxes were reported after both TIF, but not more significantly at 1 year. Symptoms improved after both TIF up to 1 year (P < 0.0001), but to a greater extent in MUSE patients up to 3 years (P < 0.0001 vs. P < 0.01 for EsophyX2.0). The rates of 3‐year off‐PPI therapy patients were 73.5% in the MUSE and 53.3% in the EsophyX2.0 series (P = 0.069).ConclusionAlthough no conclusion could be drawn from this limited study, the MUSE technique seemed more effective in the long term in patients with hiatal hernia; however, there were more severe adverse events than with EsophyX2.0.

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Transoral incisionless fundoplication with Medigus ultrasonic surgical endostapler (MUSE) for the treatment of gastro-esophageal reflux disease: outcomes up to 3 years

Cited by 4 publications

References 21 publications

Robotic revision surgery after failed Nissen anti-reflux surgery: a single center experience and a literature review

Robotic revision surgery after failed Nissen anti-reflux surgery: a single center experience and a literature review

The long-term efficacy of transoral incisionless fundoplication with Medigus Ultrasonic Surgical Endostapler (MUSE) for gastroesophageal reflux disease

Comparison of EsophyX2.0 and MUSE systems for transoral incisionless fundoplication: Technical aspects and outcomes up to 3 years

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