Transoral Fundoplication for Treatment of Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) is a very common disorder that can be currently treated by medical therapy, surgery, or endoscopic transoral interventions. Medical therapy is the most common approach. However, concerns have been raised in recent years with regard to the potential side effects of continuous long-term medication, drug intolerance or unresponsiveness, and the need for high dosages for long periods to treat symptoms or prevent recurrences. Surgery may have in some cases consequences such as long-lasting dysphagia, flatulence, inability to belch or vomit, diarrhea, or functional dyspepsia related to delayed gastric emptying. Transoral incisionless fundoplication (TIF) has recently been proved to be an effective therapeutic option as an alternative to medical and surgical therapy. TIF reconfigures the tissue to obtain a full-thickness gastroesophageal valve from inside the stomach, through serosa-to-serosa plications including the muscle layers. This chapter describes the TIF technique with the two most common used devices: the EsophyX fastener delivery system (EsophyX®) and the Medigus ultrasonic surgical endostapler (MUSE™) system. Techniques, steps, complications, and indications are described in detail. Moreover, the recent literature regarding TIF outcomes is reviewed. To date TIF has achieved long-lasting improvement of GERD symptoms (up to 10 years), with cessation or reduction of proton pump inhibitor medication in about 75% of patients, as well as improvement of functional findings.