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Endoscopic antireflux procedures can be a potential management option for selected patients with chronic acid reflux.
The long standing alternative to medical management of acid reflux has been surgery (usually some type of wrap called a “fundoplication”). Endoscopic antireflux procedures offer an alternative to surgical management of reflux for appropriately selected procedures. This approach differs from a traditional fundoplication procedure, because it is performed through the mouth rather than through laparoscopy or open abdominal incisions as in traditional fundoplication. This approach is a minimally invasive treatment for GERD designed to treat the symptoms of GERD by reinforcing the physical barrier to acid reflux at the gastroesophageal junction, while minimizing post-operative side effects such as dysphagia, gas bloat, and flatulence.
The main endoscopic procedure available for this approach has been commonly referred to as transoral incisionless fundoplication (TIF). Transoral fundoplication is designed to treat the symptoms of GERD by augmenting the barrier to acid reflux at the gastroesophageal junction, while minimizing post-operative side effects that can complicate a minority of surgical fundoplication procedures. During a TIF procedure, a patient is placed under general anesthesia and the device specifically designed and approved for this procedure is introduced with a flexible endoscope the mouth and into the stomach, where the fundoplication procedure is performed under constant visualization. TIF augments the anti-reflux barrier creating a “valve” of tissue 2 to 4 cm in length and greater than 270-degree circumferential wrap, thus restoring the dynamics of the angle of His, located between the entrance to the stomach and the esophagus, forming a valve that prevents reflux from entering the esophagus and causing inflammation. This procedure can be offered to GERD patients that meet particular criteria, often after discussion in a multidisciplinary setting.
V. Raman Muthusamy, MD, MAS, UCLA interventional endoscopist, discusses transoral incisionless fundoplication (TIF) - have we finally found an endoscopic treatment for GERD?