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Surgical Endoscopy
Published in: Surgical Endoscopy 3/2014

01-03-2014

Effect of transoral incisionless fundoplication on reflux mechanisms

Authors: Nicolaas F. Rinsma, Fabiënne G. Smeets, Daisy W. Bruls, Boudewijn F. Kessing, Nicole D. Bouvy, Ad A. M. Masclee, José M. Conchillo

Published in: Surgical Endoscopy | Issue 3/2014

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Abstract

Objectives

Transoral incisionless fundoplication (TIF) is a new endoscopic treatment option for gastroesophageal reflux disease (GERD). The mechanisms underlying the anti-reflux effect of this new procedure have not been studied. We therefore conducted this explorative study to evaluate the effect of TIF on reflux mechanisms, focusing on transient lower esophageal sphincter relaxations (TLESRs) and esophagogastric junction (EGJ) distensibility.

Methods

GERD patients (N = 15; 11 males, mean age 41 years, range 23–66), dissatisfied with medical treatment were studied before and 6 months after TIF. We performed 90-min postprandial combined high-resolution manometry and impedance-pH monitoring and an ambulatory 24-h pH-impedance monitoring. EGJ distensibility was evaluated using an endoscopic functional luminal imaging probe before and directly after the procedure.

Results

TIF reduced the number of postprandial TLESRs (16.8 ± 1.5 vs. 9.2 ± 1.3; p < 0.01) and the number of postprandial TLESRs associated with reflux (11.1 ± 1.6 vs. 5.6 ± 0.6; p < 0.01), but the proportion of TLESRs associated with reflux was unaltered (67.6 ± 6.9 vs. 69.9 ± 6.3 %). TIF also led to a decrease in the number and proximal extent of reflux episodes and an improvement of acid exposure in the upright position; conversely, TIF had no effect on the number of gas reflux episodes. EGJ distensibility was reduced after the procedure (2.4 ± 0.3 vs. 1.6 ± 0.2 mm2/mmHg; p < 0.05).

Conclusions

TIF reduced the number of postprandial TLESRs, the number of TLESRs associated with reflux and EGJ distensibility. This resulted in a reduction of the number and proximal extent of reflux episodes and improvement of acid exposure in the upright position. The anti-reflux effect of TIF showed to be selective for liquid-containing reflux only, thereby preserving the ability of venting gastric air.
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Metadata
Title
Effect of transoral incisionless fundoplication on reflux mechanisms
Authors
Nicolaas F. Rinsma
Fabiënne G. Smeets
Daisy W. Bruls
Boudewijn F. Kessing
Nicole D. Bouvy
Ad A. M. Masclee
José M. Conchillo
Publication date
01-03-2014
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 3/2014
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-013-3250-7

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