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The evolution of TIF: transoral incisionless fundoplication

Transoral incisionless fundoplication (TIF) was introduced in 2006 as a concerted effort to produce a natural orifice procedure for reflux. Since that time, the device, as well as the procedure technique, has evolved. Significant research has been published during each stage of the evolution, and this has led to considerable confusion and a co-mingling of outcomes, which obscures the results of the current device and procedure.

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 Is GERD giving you grief? New TIF procedure could be the answer

GERD can occur for a variety of reasons. One of the most common causes is a leaky valve at the bottom of the esophagus, which allows stomach acid to back up where it shouldn’t. Another cause is a hiatal hernia, which occurs when a small part of the stomach pushes up through the diaphragm. In many cases, TIF can solve these problems. Short for transoral incisionless fundoplication, the procedure allows us to tighten the leaky valve — without a surgical incision. Instead, we pass an instrument called an endoscope through the patient’s mouth and into the stomach. Using the device, we use sutures (stitches) to tighten and lengthen the valve.

Articles of Interest

Incisionless Relief for GERD (TIF)

We employ the TIF or Transoral Incisionless Fundoplication procedure to correct severe GERD that causes significant quality of life issues. As its name suggests, the procedure does not require any incisions and the entire surgery is performed through the mouth, using the specially made EsophyX device. The TIF procedure essentially rebuilds the barrier between the stomach and esophagus, eliminating acid and non-acid-related symptoms. This is particularly appealing to patients who do not wish to undergo traditional laparoscopic surgery, which may leave unsightly scarring and has several side effects.

Complications of Antireflux Surgery

Antireflux surgery anatomically restores the antireflux barrier and is a therapeutic option for proton pump inhibitor (PPI) refractory gastroesophageal reflux disease or PPI intolerance. Laparoscopic fundoplication is the standard antireflux surgery, though its popularity has declined due to concerns regarding wrap durability and adverse events. As the esophagogastric junction is an anatomically complex and dynamic area subject to mechanical stress, wraps are susceptible to disruption, herniation or slippage.

Controversies in the treatment of gastroesophageal reflux and achalasia

The immense success of laparoscopic surgery as an effective treatment of gastroesophageal reflux disease (GERD) and achalasia has established minimal invasive surgery as the gold standard for these two conditions with lower morbidity and mortality, shorter hospital stay, faster convalescence, and less postoperative pain. One controversy in the treatment of GERD evolves around laparoscopic antireflux surgery (LARS) as the preferred treatment for Barrett’s esophagus and the procedure’s potential to reduce the risk of adenocarcinoma of the esophagus.

Fundoplication: Old Concept for Novel Challenges?

For 70 years, the 360° Nissen fundoplication has dominated the surgical scenario and is still considered the gold-standard treatment. However, over the past two decades, the Toupet and Dor partial fundoplications have emerged as alternative options to decrease the incidence of dysphagia and gas-bloat syndrome. Randomized and observational clinical studies have shown that the outcomes of partial fundoplication compare favorably with those of the Nissen and can provide satisfactory quality of life minimizing the risk of side effects. However, reflux control and anatomical integrity of partial fundoplications may fade away over time. Further research and close scrutiny of new surgical procedures and technologies is in progress to improve clinical outcomes and provide a more personalized and durable antireflux therapy.

Life-Changing Procedure Now Available for Reflux Patients

TIF is an endoscopic procedure that reconstructs the valve between the stomach and esophagus (the passageway between the mouth and stomach). It can be beneficial in patients whose GERD symptoms are not managed well with other treatments such as antacids and acid suppressing drugs such as proton pump inhibitors (PPIs).

Long-term reported outcomes of transoral incisionless fundoplication: an 8-year cohort study

Transoral incisionless fundoplication (TIF) offers an endoscopic approach to the treatment of gastroesophageal reflux disease (GERD). Controlled trials have demonstrated the short-term efficacy of this procedure, but long-term follow-up studies are lacking.

Nissen Fundoplication

With the advent of laparoscopy, anti-reflux procedures are becoming a more commonly accepted method for the treatment of gastroesophageal reflux disease. There are three main types of LARS, and the two most commonly performed are the complete and partial posterior wraps.

The Pros and Cons of Partial Versus Total Fundoplication for Gastroesophageal Reflux Disease

Laparoscopic Nissen fundoplication is currently the most commonly performed procedure for gastroesophageal reflux disease (GERD). In patients with inefficient esophageal motility, a partial fundoplication such as a Toupet 270-degree posterior fundoplication is often recommended.

Toupet versus Nissen fundoplication for gastroesophageal reflux disease: are the outcomes different?

In an attempt to reduce the potential side-effects of the Nissen operation, partial fundoplication has emerged as the procedure of choice or as a “tailored” option for patients with poor esophageal motility. Systematic reviews and meta-analyses have shown that the Toupet fundoplication can decrease the incidence of dysphagia and gas-bloating compared to Nissen fundoplication

Transoral Incisionless Fundoplication (TIF)

Multiple national studies have shown that the TIF procedure is performed successfully in up to 99% of patients, with just 2% experiencing issues during or after the procedure, such as a tear or internal bleeding. For a large number of patients, TIF provides significant GERD symptom relief and improved quality of life. Most patients (91%) also experience reduction in hiatal hernia and many (89%) are able to stop taking PPI medicine.

Types of fundoplication surgery

Nissen fundoplication: the fundus is wrapped completely around the lower esophageal sphincter. Toupet fundoplication: the fundus is wrapped only partly around the lower esophageal sphincter, usually about two-thirds of the way, starting from the back. Dor fundoplication: the fundus is wrapped partly around the lower esophageal sphincter, but unlike the toupet fundoplication, the wrapping begins from the front.

Resources

EndoGastric Solutions

The TIF 2.0® (Transoral Incisionless Fundoplication) procedure is an advanced endoscopic treatment that reconstructs the gastroesophageal flap valve (GEFV)—targeting the root anatomical cause of GERD (Gastroesophageal Reflux Disease). By restoring the natural antireflux barrier, TIF 2.0 offers a physiological solution without the need for external incisions or dissection.

TIF Procedure

The TIF procedure is minimally invasive and corrects the root cause of reflux – a faulty valve between the esophagus and stomach. If you are taking proton pump inhibitors such as Prilosec® and Nexium® to control your symptoms, you now have a safe and effective alternative.