The TIF procedure treats GERD transorally (through the mouth). TIF in Denver improves reflux symptoms more effectively than anti-acid medications, and it enables many patients to stop taking anti-acid medications altogether. No incisions are required, and recovery is even faster than the laparoscopic fundoplication.
The EsophyX procedure reinforces the gastroesophageal junction by folding (plicating) the upper portion of the stomach (the fundus) around the gastroesophageal junction for about 270 degrees and securing it in place by special fasteners. It is based on the same principles that have been shown to be effective in the Nissen fundoplication.
It is FDA approved and has been in use since 2006. We began performing this procedure in November 2008. To date, we have performed over 180 procedures, representing one of the largest practices with TIF experience in the United States.
The goal of any GERD treatment is to alleviate GERD symptoms with the lowest risk and degree of side effects. The EsophyX TIF procedure can be successful at improving GERD symptoms without the need for supplemental medication. In other instances, medication and TIF together are required to alleviate symptoms. The endpoint of treatment is to improve the quality of life for GERD patients.
The TIF procedure frequently works better than medical therapy alone (e.g. Prilosec, Nexium, Protonix, etc.) in allowing patients to eat spicy, acidic, or other reflux-causing foods. EsophyX also enables more patients to exercise and sleep without reflux symptoms. As medication infrequently alleviates laryngeal reflux (LPR) symptoms, the EsophyX TIF procedure may be an appropriate option for patients with these symptoms.
The TIF procedure is in general limited to patients with no or small hiatal hernias (< 3 cm) and a body mass index (BMI) < 35, and laparoscopic fundoplication is not.
The TIF procedure was initially evaluated in Europe by Professor Guy-Bernard Cadiere in Brussels and NIcole Bouvy in Maastricht, Netherlands. Both of their series demonstrated that over 75% of patients were able to stop using acid-suppressive medication as a result of the procedure. A two year follow-up published by Professor Cadiere reported that 79% of patients experienced complete cure or remission of their GERD symptoms.
In May 2010, we completed a review of our first 37 patients at a median of 6 months after the procedure. We found that 82% were off of acid-suppressive medication with significant improvement in their quality of life (measured by standardized questionnaires).
Additionally, reflux testing demonstrated that 73% of patients had a significant improvement in the amount of acid reflux present, which is better than other reported series of the TIF with EsophyX procedure.
In order to be a candidate for TIF using EsophyX, patients must have gastroesophageal reflux disease and a reducible hiatal hernia of 2 cm or less. We often confirm that a patient has GERD by a pH or impedance test. We assess hiatal hernia by a upper GI X-ray series and/or upper GI endoscopy.
Patients with significant obesity (BMI >35), Barrett’s esophagus, or significant narrowing in the upper esophagus, are generally not candidates for the procedure.
The EsophyX procedure is performed under a general anesthetic in an operating room. The procedure takes 1-2 hours. A flexible endoscope is introduced through the mouth into the stomach to visualize the operation. The EsophyX device slips over the endoscope and into the lower esophagus and stomach.
The EsophyX device then folds the stomach wall against the esophagus. This recreates the flap-valve mechanism and reduces the hiatal hernia. Once tissues are properly positioned, the surgeon places H-shaped-fasteners in between the esophagus and stomach wall using the EsophyX device. These H-fasteners function like sutures to hold the valve mechanism in place.
Following the TIF procedure, patients are typically observed overnight and go home the following day. They are started on liquids the day of the procedure and follow a graduated diet plan for the next month. Pain in the upper abdomen, throat, or chest is typically short-lived. Nausea, though not frequent, is treated with anti-nausea medications to prevent disruption of the repair.
It is best to follow our recovery directions as closely as possible. Many patients return to desk work or light duty within a week. Stairs, walking, and mild aerobic activity are permitted immediately. Strenuous physical activity including heavy lifting is limited for 4-6 weeks to allow the tissues to adequately bond to one another.
Patients stop taking anti-acid medication after two weeks, and typically notice that their GERD symptoms like heartburn and reflux are gone. They can sleep better without having to be upright, and can enjoy acidic foods more often.
To find out more about TIF using EsophyX, Denver patients can contact the Institute of Esophageal and Reflux Surgery for a consultation. Make your appointment today to learn about whether this GERD treatment option is right for you.