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Review
. 2021 Feb;9(2):E239-E246.
doi: 10.1055/a-1322-2209. Epub 2021 Feb 3.

Long-term outcomes of transoral incisionless fundoplication for gastro-esophageal reflux disease: systematic-review and meta-analysis

Sabrina Testoni  1 , Cesare Hassan  2 , Giorgia Mazzoleni  3 , Giulio Antonelli  2 , Lorella Fanti  4 , Sandro Passaretti  4 , Loredana Correale  5 , Giulia Martina Cavestro  4 , Pier Alberto Testoni  4
Affiliations
Review

Long-term outcomes of transoral incisionless fundoplication for gastro-esophageal reflux disease: systematic-review and meta-analysis

Sabrina Testoni et al. Endosc Int Open. 2021 Feb.

Abstract

Background and study aims Few reports exist about long-term outcomes of transoral incisionless fundoplication (TIF) for treating refractory gastro-esophageal reflux disease (GERD). Methods A literature search of four major scientific databases was performed up to May 2020 for studies reporting on more than 3-year outcomes of TIF. Data on atient satisfaction, proton pump inhibitor (PPI) daily consumption, PPI use reduction, GERD health-related quality-of-life (GERD-HRQL) score, and normalization of heartburn and regurgitation scores were pooled and summarized with forest plots. Publication bias and heterogeneity were explored. Results Overall, eight studies (418 patients, 232 men; 55.5 %) with a mean follow-up of 5.3 years (range: 3-10 years) were included. The pooled proportion of patient-reported satisfaction before and after TIF was 12.3 % (95 % CI:12.3-35.1 %, I 2 = 87.4 %) and 70.6 % (95 % CI:51.2-84.6, I 2 = 80 %), respectively, corresponding to an odds ratio of 21.4 (95 % CI:3.27-140.5). Pooled rates of patients completely off PPIs and on occasional PPIs were 53.8 % (95 %CI: 42.0 %-65.1 %) and 75.8 % (95 %CI: 67.6-82.6), respectively. The pooled estimated mean GERD-HRQL scores off PPI before and after TIF werey 26.1 (95 %CI: 21.5-30.7; range: 20.0-35.5) and 5.9, respectively (95 %CI:0.35.1-11.4; range: 5.3-9.8; P < 0.001). The overall pooled rates of heartburn and regurgitation scores normalization were 73.0 % (95 %CI: 0.62-0.82) and 86 %, respectively (95 %CI: 75.0-91.0 %). Conclusion Our study shows that TIF appears to offer a long-term safe therapeutic option for selected patients with GERD who refuse life-long medical therapy or surgery, are intolerant to PPIs, or are at increased surgical risk.

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Conflict of interest statement

Competing interests The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Excluded studies and reasons for their exclusion.
Fig. 2
Fig. 2
Meta-analysis of patient-reported satisfaction after TIF.
Fig. 3
Fig. 3
Meta-analysis of patients who were completely free of PPIs.
Fig. 4
Fig. 4
Meta-analysis of patients who were completely free of PPIs or took them occasionally.
See this image and copyright information in PMC

References

    1. Huang X, Chen S, Zhao H et al.Efficacy of transoral incisionless fundoplication (TIF) for the treatment of GERD: a systematic review with meta-analysis. Surg Endosc. 2017;31:1032–1044. - PubMed
    1. McCarty T R, Itidiare M, Njei B et al.Efficacy of transoral incisionless fundoplication for refractory gastroesophageal reflux disease: a systematic review and meta-analysis. Endoscopy. 2018;50:708–725. - PubMed
    1. Richter J E, Kumar A, Lipka S et al.Efficacy of laparoscopic nissen fundoplication vs transoral incisionless fundoplication or proton pump inhibitors in patients with gastroesophageal reflux disease: a systematic review and network meta-analysis. Gastroenterology. 2018;154:1298–1308. - PubMed
    1. Liberati A, Altman D G, Tetzlaff J et al.The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med. 2009;151:W65–W94. - PubMed
    1. Moga C, Guo B, Schopflocher D.Development of a quality appraisal tool for case series studies using a modified Delphi technique Inst Health Econ; 2012. Available at:https://www.ihe.ca/advanced-search/development-of-a-quality-appraisal-to...