Transoral incisionless fundoplication

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Transoral incisionless fundoplication
Specialty Gastroenterology

Transoral incisionless fundoplication (TIF) is an endoscope treatment designed to relieve symptoms of gastroesophageal reflux disease (GERD). The TIF procedure, similar to Nissen fundoplication, alleviates GERD symptoms by wrapping a portion of the stomach around the esophagus. [1]

Contents

The TIF procedure, unlike laparoscopic fundoplication, does not require surgical incisions. Instead a surgical device (called the EsophyX) is inserted into the mouth, passed through the throat, and into the stomach. An endoscope is utilized to perform the procedure. [2]

A minority of individuals who undergo the TIF procedure also require a hiatal hernia repair operation. [3] The procedure is performed while the person is under general anesthesia [4] and is typically an outpatient procedure. [1]

Medical use

Transoral incisionless fundoplication may improve symptoms in gastroesophageal reflux disease, at least in the short term. [5] Benefits from the TIF procedure may last for up to 6 years. [6]

Complications

The risk of severe complications is 2.4%. [7] About 1 in 30 people have major complications from the procedure. [5]

History

The device utilized to perform the procedure, called EsophyX, was developed by EndoGastric Solutions. The first TIF procedure utilizing the device was performed in 2005. [8] The device received European Union CE mark in 2006 and United States Food and Drug Administration issued initial 510(k) clearance in 2007. [2] [9]

In February 2015, the American Medical Association's CPT Editorial Panel reviewed whether to create a new category 1 current procedural terminology (CPT) code for the TIF procedure. In January 2016, a unique code for the transoral incisionless fundoplication procedure was created and implemented. [10]

As of 2016, more than 17,000 TIF procedures had been performed. [8]

In July 2016, Health Care Service Corporation (HCSC) became the first United States health insurance company to add the TIF procedure to their medical coverage policy. HSCS added the TIF procedure to their health insurance policy at the recommendation of both the American Gastroenterological Association (AGA) and The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). [11]

Other options

The TIF procedure is not the ideal GERD solution for all people. Other medical and endoscopic treatments to alleviate GERD symptoms include: Stretta procedure [12] and proton-pump inhibitors (PPIs). [13]

Related Research Articles

Esophageal achalasia Rare, incurable, progressive motility disorder due to failure of esophogeal motor neurons

Esophageal achalasia, often referred to simply as achalasia, is a failure of smooth muscle fibers to relax, which can cause the lower esophageal sphincter to remain closed. Without a modifier, "achalasia" usually refers to achalasia of the esophagus. Achalasia can happen at various points along the gastrointestinal tract; achalasia of the rectum, for instance, may occur in Hirschsprung's disease. The lower esophageal sphincter is a muscle between the esophagus and stomach that opens when food comes in. It closes to avoid stomach acids from coming back up. A fully understood cause to the disease is unknown, as are factors that increase the risk of its appearance. Suggestions of a genetically transmittable form of Achalasia exist, but this is neither fully understood, nor agreed upon.

Heartburn, also known as pyrosis, cardialgia or acid indigestion, is a burning sensation in the central chest or upper central abdomen. Heartburn is usually due to regurgitation of gastric acid into the esophagus. It is the major symptom of gastroesophageal reflux disease (GERD).

Gastroesophageal reflux disease Medical condition

Gastroesophageal reflux disease (GERD), is a chronic condition in which stomach contents rise up into the esophagus, resulting in symptoms and/or complications. Symptoms include the taste of acid in the back of the mouth, heartburn, bad breath, chest pain, regurgitation, breathing problems, and wearing away of the teeth. Complications include esophagitis, esophageal stricture, and Barrett's esophagus.

Barretts esophagus Medical condition

Barrett's esophagus is a condition in which there is an abnormal (metaplastic) change in the mucosal cells lining the lower portion of the esophagus, from normal stratified squamous epithelium to simple columnar epithelium with interspersed goblet cells that are normally present only in the small intestine and large intestine. This change is considered to be a premalignant condition because it is associated with a high incidence of further transition to esophageal adenocarcinoma, an often-deadly cancer.

Endoscopy Procedure used in medicine to look inside the body

An endoscopy is a procedure used in medicine to look inside the body. The endoscopy procedure uses an endoscope to examine the interior of a hollow organ or cavity of the body. Unlike many other medical imaging techniques, endoscopes are inserted directly into the organ.

Esophagitis Medical condition

Esophagitis, also spelled oesophagitis, is a disease characterized by inflammation of the esophagus. The esophagus is a tube composed of a mucosal lining, and longitudinal and circular smooth muscle fibers. It connects the pharynx to the stomach; swallowed food and liquids normally pass through it.

Hiatal hernia Type of hernia in which abdominal organs (typically the stomach) slip through the diaphragm into the middle compartment of the chest

A hiatal hernia is a type of hernia in which abdominal organs slip through the diaphragm into the middle compartment of the chest. This may result in gastroesophageal reflux disease (GERD) or laryngopharyngeal reflux (LPR) with symptoms such as a taste of acid in the back of the mouth or heartburn. Other symptoms may include trouble swallowing and chest pains. Complications may include iron deficiency anemia, volvulus, or bowel obstruction.

Nissen fundoplication Surgical procedure to treat gastric reflux and hiatal hernia

A Nissen fundoplication, or laparoscopic Nissen fundoplication when performed via laparoscopic surgery, is a surgical procedure to treat gastroesophageal reflux disease (GERD) and hiatal hernia. In GERD, it is usually performed when medical therapy has failed; but, with a Type II (paraesophageal) hiatus hernia, it is the first-line procedure. The Nissen fundoplication is total (360°), but partial fundoplications known as Thal, Belsey, Dor, Lind, and Toupet fundoplications are alternative procedures with somewhat different indications and outcomes.

Esophagogastroduodenoscopy

Esophagogastroduodenoscopy, also called by various other names, is a diagnostic endoscopic procedure that visualizes the upper part of the gastrointestinal tract down to the duodenum. It is considered a minimally invasive procedure since it does not require an incision into one of the major body cavities and does not require any significant recovery after the procedure. However, a sore throat is common.

Endoscopic retrograde cholangiopancreatography Use of endoscopy and fluoroscopy to treat and diagnose digestive issues.

Endoscopic retrograde cholangiopancreatography (ERCP) is a technique that combines the use of endoscopy and fluoroscopy to diagnose and treat certain problems of the biliary or pancreatic ductal systems. It is primarily performed by highly skilled and specialty trained gastroenterologists. Through the endoscope, the physician can see the inside of the stomach and duodenum, and inject a contrast medium into the ducts in the biliary tree and pancreas so they can be seen on radiographs.

TIF or Tagged Image File Format is a file format for storing images.

Eosinophilic esophagitis Esophagus inflammation

Eosinophilic esophagitis (EoE) is an allergic inflammatory condition of the esophagus that involves eosinophils, a type of white blood cell. In healthy individuals, the esophagus is typically devoid of eosinophils. In EoE, eosinophils migrate to the esophagus in large numbers. When a trigger food is eaten, the eosinophils contribute to tissue damage and inflammation. Symptoms include swallowing difficulty, food impaction, vomiting, and heartburn.

Stretta is a minimally invasive endoscopic procedure for the treatment of gastroesophageal reflux disease (GERD) that delivers radiofrequency energy in the form of electromagnetic waves through electrodes at the end of a catheter to the lower esophageal sphincter (LES) and the gastric cardia – the region of the stomach just below the LES. The energy heats the tissue, ultimately causing it to swell and stiffen; the way this works was not understood as of 2015, but it was thought that perhaps the heat causes local inflammation, collagen deposition and muscular thickening of the LES and that it may disrupt the nerves there.

Capsule endoscopy

Capsule endoscopy is a procedure used to record internal images of the gastrointestinal tract for use in medical diagnosis. Newer developments are also able to take biopsies and release medication at specific locations of the entire gastrointestinal tract. The capsule is similar in shape to a standard pharmaceutical capsule, although a little larger, and contains a tiny image sensor and an array of LEDs powered by a battery. After a patient swallows the capsule, it passes along the gastrointestinal tract taking a number of images per second which are transmitted wirelessly to an array of receivers connected to a portable recording device carried by the patient. The primary use of capsule endoscopy is to examine areas of the small intestine that cannot be seen by other types of endoscopy such as colonoscopy or esophagogastroduodenoscopy (EGD).

Therapeutic endoscopy is the medical term for an endoscopic procedure during which treatment is carried out via the endoscope. This contrasts with diagnostic endoscopy, where the aim of the procedure is purely to visualize a part of the gastrointestinal, respiratory or urinary tract in order to aid diagnosis. In practice, a procedure which starts as a diagnostic endoscopy may become a therapeutic endoscopy depending on the findings, such as in cases of upper gastrointestinal bleeding, or the finding of polyps during colonoscopy.

Impedance–pH monitoring

Impedance–pH monitoring is a technique used in the diagnosis of gastroesophageal reflux disease (GERD), by monitoring both impedance and pH.

Esophageal pH monitoring

Esophageal pH monitoring is the current gold standard for diagnosis of gastroesophageal reflux disease (GERD). It provides direct physiologic measurement of acid in the esophagus and is the most objective method to document reflux disease, assess the severity of the disease and monitor the response of the disease to medical or surgical treatment. It can also be used in diagnosing laryngopharyngeal reflux.

The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) is a 501c6 non-profit professional organization providing education on gastrointestinal minimally invasive surgery. It describes itself thus: The mission of the Society of American Gastrointestinal and Endoscopic Surgeons is to innovate, educate and collaborate to improve patient care.

The per-oral endoscopic myotomy, or POEM, is a minimally invasive surgical procedure for the treatment of achalasia wherein the inner circular muscle layer of the lower esophageal sphincter is divided through a submucosal tunnel. This enables food and liquids to pass into the stomach, a process that is impaired in achalasia. The tunnel is created, and the myotomy performed, using a flexible endoscope, meaning the entire procedure can be done without external incisions.

Lymphocytic esophagitis Medical condition

Lymphocytic esophagitis is a rare and poorly understood medical disorder involving inflammation in the esophagus. The disease is named from the primary inflammatory process, wherein lymphocytes are seen within the esophageal mucosa. Symptoms of the condition include difficulty swallowing, heartburn and food bolus obstruction. The condition was first described in 2006 by Rubio and colleagues. Initial reports questioned whether this was a true medical disorder, or whether the inflammation was secondary to another condition, such as gastroesophageal reflux disease.

References

  1. 1 2 "Is It GERD? Recognizing Atypical Symptoms | Physician's Weekly for Medical News, Journals & Articles". www.physiciansweekly.com. Retrieved 2017-05-18.
  2. 1 2 "GERD Device Maker Uses Clinical Data to Prove Its Point | MDDI Medical Device and Diagnostic Industry News Products and Suppliers". www.mddionline.com. 2015-03-12. Retrieved 2017-05-18.
  3. ↑ Kennedy, Sam. "New Easton Hospital procedure fixes heartburn". themorningcall.com. Retrieved 2017-06-06.
  4. ↑ "MCW: Endoscopic Transoral Incisionless Fundoplication". www.mcw.edu. Retrieved 2017-05-18.
  5. 1 2 Wendling, MR; Melvin, WS; Perry, KA (October 2013). "Impact of transoral incisionless fundoplication (TIF) on subjective and objective GERD indices: a systematic review of the published literature". Surgical Endoscopy. 27 (10): 3754–61. doi:10.1007/s00464-013-2961-0. PMID   23644835.
  6. ↑ Hopkins, Jessica; Switzer, Noah J; Karmali, Shahzeer (2015-08-25). "Update on novel endoscopic therapies to treat gastroesophageal reflux disease: A review". World Journal of Gastrointestinal Endoscopy. 7 (11): 1039–1044. doi:10.4253/wjge.v7.i11.1039. ISSN   1948-5190. PMC   4549661 . PMID   26322157.
  7. ↑ Nabi, Z; Reddy, DN (July 2019). "Update on Endoscopic Approaches for the Management of Gastroesophageal Reflux Disease". Gastroenterology & hepatology. 15 (7): 369–376. PMID   31391807.
  8. 1 2 Sami Trad, Karim (2017-05-10). "Transoral incisionless fundoplication: current status". Current Opinion in Gastroenterology. 32 (4): 338–343. doi:10.1097/MOG.0000000000000275. ISSN   0267-1379. PMC   4894777 . PMID   27023164.
  9. ↑ "Incision-free surgery treats acid reflux: Allegan surgeon is training other doctors to do the procedure". MLive.com. Retrieved 2017-05-10.
  10. ↑ "AMA creates CPT code for transoral incisionless fundoplication procedure for GERD". www.healio.com. Retrieved 2017-06-06.
  11. ↑ "TIF procedure for reflux now covered by Blue Cross Blue Shield of Texas". Plainview Daily Herald. Retrieved 2017-05-10.
  12. ↑ Hopkins, Jessica; Switzer, Noah J.; Karmali, Shahzeer (2015-08-25). "Update on novel endoscopic therapies to treat gastroesophageal reflux disease: A review". World Journal of Gastrointestinal Endoscopy. 7 (11): 1039–1044. doi:10.4253/wjge.v7.i11.1039. PMC   4549661 . PMID   26322157.
  13. ↑ Trad, Karim S.; Barnes, William E.; Simoni, Gilbert; Shughoury, Ahmad B.; Mavrelis, Peter G.; Raza, Mamoon; Heise, Jeffrey A.; Turgeon, Daniel G.; Fox, Mark A. (2017-05-15). "Transoral Incisionless Fundoplication Effective in Eliminating GERD Symptoms in Partial Responders to Proton Pump Inhibitor Therapy at 6 Months". Surgical Innovation. 22 (1): 26–40. doi:10.1177/1553350614526788. ISSN   1553-3506. PMC   4361451 . PMID   24756976.
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