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. 2024 Jul 1;30(4):266-271.
doi: 10.4103/sjg.sjg_22_24. Epub 2024 Mar 11.

The role of transoral incisionless fundoplication (TIF) in the management of gastroesophageal reflux disease (GERD) following peroral endoscopic myotomy (POEM): A pilot, prospective, patient-driven study

Fares Ayoub  1 , Tara Keihanian, Noor Zabad, Salmaan Jawaid, Kalpesh Patel, Mohamed O Othman
Affiliations

The role of transoral incisionless fundoplication (TIF) in the management of gastroesophageal reflux disease (GERD) following peroral endoscopic myotomy (POEM): A pilot, prospective, patient-driven study

Fares Ayoub et al. Saudi J Gastroenterol. .

Abstract

Background: Gastroesophageal reflux (GERD) is a concern after peroral endoscopic myotomy (POEM). Transoral incisionless fundoplication (TIF) has been recently described as a possible therapy for post-POEM GERD in case series.

Methods: We prospectively enrolled patients undergoing POEM who agreed to participate in objective post-procedure GERD evaluation. Patients with objective evidence of GERD and suitable anatomy were offered TIF vs. proton pump inhibitor (PPI) only. Patients who underwent TIF were compared to those on PPI-only therapy after follow-up.

Results: Of 21 enrolled POEM patients with objective testing, GERD was found in 11 (52%). Of those eligible for TIF, 4 (40%) opted to pursue TIF and were compared to those on PPI-only therapy ( n = 6). Three months post-TIF, 75% of patients had discontinued or significantly decreased PPI. There were no adverse events. GERD health-related quality of life scores were low and comparable between TIF (3.75 ± 6.2) and those who remained on PPI-only therapy (4.1 ± 5).

Conclusion: In this pilot, patient-driven prospective study, 75% of patients with post-POEM GERD undergoing TIF had stopped or significantly reduced PPI use. Post-POEM TIF is safe and effective and may be a viable alternative to PPI for POEM-related GERD; however, future studies should include a control arm and post-intervention pH monitoring.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Peroral endoscopic myotomy (POEM) procedure. (a) ”Rosette” sign at the gastroesophageal junction in a patient with achalasia, (b) tunneling through the submucosal layer of the esophagus, (c) full thickness myotomy, and (d) closure of the mucosal entry site
Figure 2
Figure 2
Transoral incisionless fundoplication (TIF) procedure. (a) gastroesophageal junction on retroflexion with a Hill Grade II valve, (b and c) TIF device during plication, and (d) Reconstructed gastroesophageal flap valve following TIF
Figure 3
Figure 3
Sankey diagram demonstrating the flow of post-POEM patients with objective evidence of gastroesophageal reflux disease (GERD)
See this image and copyright information in PMC

References

    1. Werner YB, Hakanson B, Martinek J, Repici A, von Rahden BHA, Bredenoord AJ, et al. Endoscopic or surgical myotomy in patients with idiopathic Achalasia. N Engl J Med. 2019;381:2219–29. - PubMed
    1. Repici A, Fuccio L, Maselli R, Mazza F, Correale L, Mandolesi D, et al. GERD after per-oral endoscopic myotomy as compared with Heller's myotomy with fundoplication: A systematic review with meta-analysis. Gastrointest Endosc. 2018;87:934–43.e18. - PubMed
    1. Witteman BPL, Conchillo JM, Rinsma NF, Betzel B, Peeters A, Koek GH, et al. Randomized controlled trial of transoral incisionless fundoplication Vs. proton pump inhibitors for treatment of gastroesophageal reflux disease. Am J Gastroenterol. 2015;110:531–42. - PubMed
    1. Brewer Gutierrez OI, Chang KJ, Benias PC, Sedarat A, Dbouk MH, Godoy Brewer G, et al. Is transoral incisionless fundoplication (TIF) an answer to post-peroral endoscopic myotomy gastroesophageal reflux?A multicenter retrospective study. Endoscopy. 2022;54:305–9. - PubMed
    1. Schlottmann F, Luckett DJ, Fine J, Shaheen NJ, Patti MG. Laparoscopic Heller myotomy versus peroral endoscopic myotomy (POEM) for Achalasia: A systematic review and meta-analysis. Ann Surg. 2018;267:451–60. - PubMed

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