Is transoral incisionless fundoplication (TIF) an answer to post-peroral endoscopic myotomy gastroesophageal reflux? A multicenter retrospective study

Background: The use of peroral endoscopic myotomy (POEM) for achalasia has a high incidence of post-procedural gastroesophageal reflux (GER). Transoral incisionless fundoplication (TIF) may be an ideal endoscopic treatment. We report our experience with the use of post-POEM TIF. Methods: In this multicenter retrospective study, post-POEM patients with GER who underwent TIF were included. The study end points were: (i) technical success; (ii) safety; (iii) effectiveness (changes in symptoms, scores, proton pump inhibitor [PPI] use, pH studies). Results: 12 patients underwent TIF after POEM, nine of whom had daily symptoms, with 91.7% requiring twice daily (BID) PPIs. Technical success was achieved in all patients. Two adverse events occurred. There were significant decreases in the percentage of patients on BID PPIs ( P = 0.03), frequency of daily symptoms ( P = 0.03), Reflux Severity Index questionnaire, and GERD Health-related Quality of Life scores ( P = 0.03 and P = 0.003; n = 6). pH studies performed in seven of the patients showed a significant reduction in the mean DeMeester score ( P = 0.05) and mean percentage acid exposure time ( P = 0.04). Conclusion: Our experience suggests that TIF may be effective and safe in treating GER after POEM. Larger prospective trials are needed.

Automated summary

The study demonstrates that using transoral incisionless fundoplication (TIF) after peroral endoscopic myotomy (POEM) for treating gastroesophageal reflux (GER) may be effective and safe. Results indicate significant improvements in PPI use, symptom severity, and quality of life in post-POEM patients undergoing TIF.