Top

Published in:

01-12-2010 | 2010 SSAT Quick Shot Presentation

Transoral Incisionless Fundoplication 2.0 Procedure Using EsophyX™ for Gastroesophageal Reflux Disease

Authors: Toshitaka Hoppo, Arul Immanuel, Matthew Schuchert, Zdenek Dubrava, Andrew Smith, Peter Nottle, David I. Watson, Blair A. Jobe

Published in: Journal of Gastrointestinal Surgery | Issue 12/2010

Abstract

Background

Transoral incisionless fundoplication (TIF) using the EsophyX™ system has been introduced as a possible alternative for the treatment of gastroesophageal reflux disease (GERD). The efficacy of this procedure in our centers was evaluated.

Methods

Patients were selected for treatment if they had typical GERD symptoms, failed management with proton pump inhibitors (PPIs), a positive esophageal pH test with symptom correlation, and no hiatus hernia larger than 2 cm.

Results

Nineteen patients (11 men, 8 women) underwent the TIF procedure between April 2008 and July 2009. Mean age was 48.2 years and body mass index was 24.6. The major complication rate was 3/19, including esophageal perforation, hemorrhage requiring transfusion, and permanent numbness of tongue. At mean 10.8 months follow-up, 5/19 had completely discontinued PPIs, and 3/19 had decreased their PPI dose. However, 10/19 had been converted to laparoscopic fundoplication for recurrent reflux symptoms and an endoscopically confirmed failed valve. Nine of 17 were dissatisfied with the outcome, and eight were satisfied. Thirteen of 19 (68%) were considered to have been unsuccessful.

Conclusion

At short-term follow-up, the TIF procedure is associated with an excessive early symptomatic failure rate, and a high surgical re-intervention rate. This procedure should not be performed outside of a clinical trial.

Importance of pH control in the management of GERD. Hunt RH. Arch Intern Med 1999;159:649–57.CrossRef

Giannini EG, Zentilin P, Dulbecco P, et al. Management strategy for patients with gastroesophageal reflux disease: a comparison between empirical treatment with esomeprazole and endoscopy-oriented treatment. Am J Gastroenterol 2008;103:267–275.CrossRefPubMed

Moayyedi P, Axon AT. Review article: gastro-oesophageal reflux disease—the extent of the problem. Aliment Pharmacol Ther 2005;22(Suppl 1):11–19.CrossRefPubMed

Dallemagne B, Weerts J, Markiewicz S, Dewandre JM, Wahlen C, Monami B, Jehaes C. Clinical results of laparoscopic fundoplication at ten years after surgery. Surg Endosc 2006;20:159–165.CrossRefPubMed

Papasavas PK, Keenan RJ, Yeaney WW, Caushaj PF, Gagne DJ, Landreneau RJ. Effectiveness of laparoscopic fundoplication in relieving the symptoms of gastroesophageal reflux disease (GERD) and eliminating antireflux medical therapy. Surg Endosc 2003;17:1200–1205.CrossRefPubMed

Carlson MA, Frantzides CT. Complications and results of primary minimally invasive antireflux procedures: a review of 10,735 reported cases. J Am Coll Surg 2001;193:428–439.CrossRefPubMed

Montgomery M, Hakanson B, Ljungqvist O, et al. Twelve months’ follow-up after treatment with the EndoCinch endoscopic technique for gastro-oesophageal reflux disease: a randomized, placebo-controlled study. Scand J Gastroenterol. 2006;41:1382–1389.CrossRefPubMed

Torquati A, Richards WO. Endolumenal GERD treatments: critical appraisal of current literature with evidence-based medicine instruments. Surg Endosc. 2007;21:697–706.CrossRefPubMed

Cicala M, Gabbrielli A, Emerenziani S, et al. Effect of endoscopic augmentation of the lower oesophageal sphincter (Gatekeeper reflux repair system) on intraoesophageal dynamic characteristics of acid reflux. Gut 2005;54:183–186.CrossRefPubMed

10.

Louis H, Deviere J. Endoscopic implantation of enteryx for the treatment of gastroesophageal reflux disease: technique, pre-clinical and clinical experience. Gastrointest Endosc Clin N Am 2003;13:191–200.CrossRefPubMed

11.

Jobe BA, O’Rourke RW, McMahon BP, et al. Transoral endoscopic fundoplication in the treatment of gastroesophageal reflux disease. Ann Surg 2008;248:69–76.CrossRefPubMed

12.

Cadiere GB, Buset M, Muls V, et al. Antireflux transoral incisionless fundoplication using EsophyX: 12-month results of a prospective multicenter study. World J Surg 2008;32:1676–1688.CrossRefPubMed

13.

Bergman S, Mikami DJ, Hazey JW, et al. Endolumenal fundoplication with EsophyX: the initial north American experience. Surg Inno 2008;15(3):166–170.CrossRef

14.

Demyttenaere SV, Bergman S, Pham T, et al. Transoral incisionless fundoplication for gastroesophageal reflux disease in an unselected patient population. Surg Endosc 2009;24(4):854–8.CrossRef

15.

Cadiere GB, Sante NV, Graves JE, et al. Two-year results of a feasibility study on antireflux transoral incisionless fundoplication using EsophyX. 2009;23:957–964

16.

Repici A, Fumagalli U, Malesci A, et al. Endoluminal fundoplication (ELF) for GERD using EsophyX: a 12-month follow-up in a single-center experience. 2009;13:1–6.

17.

Testoni PA, Corsetti M, Di Pietro S, et al. Effect of transoral incisionless fundoplication on symptoms, PPI use, and pH-Impedance refluxes of GERD patients. World J Surg 2010;34(4):750–7.CrossRefPubMed

18.

Pandolfino JE, Richter JE, Ours T, et al. Ambulatory esophageal pH monitoring using a wireless system. Am J Gastroenterol 2003;98(4):740–9.CrossRefPubMed

19.

Hill LD, Kozarek RA, Kraemer SJM, et al. The gastroesophageal flap valve: in vitro and in vivo observations. Gastrointest Endosc. 1996;44:541–547.CrossRefPubMed

20.

Schilling D, Kiesslich R, Galle PR, et al. Endoluminal therapy of GERD with a new endoscopic suturing device. Gastrointest Endosc 2005;62:37–43.CrossRefPubMed

21.

Swain P, Park PO. Endoscopic suturing. Best Pract Res Clin Gastroenterol 2004;18(1):37–47.CrossRefPubMed

Title: Transoral Incisionless Fundoplication 2.0 Procedure Using EsophyX™ for Gastroesophageal Reflux Disease
Authors: Toshitaka Hoppo
Arul Immanuel
Matthew Schuchert
Zdenek Dubrava
Andrew Smith
Peter Nottle
David I. Watson
Blair A. Jobe
Publication date: 01-12-2010
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 12/2010
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-010-1331-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Transoral Incisionless Fundoplication 2.0 Procedure Using EsophyX™ for Gastroesophageal Reflux Disease

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 12/2010

Laparoscopic Repair of Large Hiatal Hernia Without Prosthetic Reinforcement: Late Results and Relevance of Anterior Gastropexy

The Long-Term Results of Distal Gastrectomy by Mini-laparotomy in Early Gastric Cancer Patients

Erratum to: The Long-Term Results of Distal Gastrectomy by Mini-laparotomy in Early Gastric Cancer Patients

Large Volume Hepatic Microwave Ablation Elicits Fewer Pulmonary Changes than Radiofrequency or Cryotherapy

Response to Reader’s Queries

The Effect of Surgical Volume and the Provision of Residency and Fellowship Training on Complications of Major Hepatic Resection