Transoral Incisionless Fundoplication (TIF)

What is TIF?

Transoral incisionless fundoplication (TIF) is an advanced endoscopy procedure to treat gastro-oesophageal reflux disease (GORD) and LPR (laryngopharyngeal reflux, sometimes referred to as silent reflux).

When a person experiences reflux issues it means the contents of the stomach (partially digested food, stomach acid and bile) leak up the food pipe (the oesophagus). It may be described by doctors as heartburn, reflux or regurgitation and is defined as chronic reflux when it is happening frequently (rather than an occasional nuisance).

Over time reflux can damage the oesophagus – up to 15% patients will go on to develop a pre-cancerous condition called Barrett’s Oesophagus. This means that the repeated exposure to stomach acid causes changes to the cell lining and the longer a person has reflux, the higher their possibility of Barrett’s and oesophageal cancer.

This is why many GORD and LPR patients are looking at permanent solutions to prevent acid reflux. Dr Rehan Haidry is an experienced Consultant Gastroenterologist and interventional endoscopist, considered one of the country’s leading experts in reflux issues, and was the first doctor in Europe to offer TIF, a pioneering alternative to conventional anti-reflux surgery.

Why TIF?

Questions and Appointments

For any enquiries about conditions, tests or treatments, please feel free to call Dr Rehan Haidry’s medical secretary Debra Hyams.

Surgery or TIF?

During anti-reflux surgery (commonly performed on the NHS for patients with GORD or Barrett’s Oesophagus) incisions are made in the abdomen and the surgeon wraps the stomach around the lowest portion of the food pipe to control reflux/regurgitation into the oesophagus (which means the cell lining damage is reduced and therefore the risk of oesophageal cancer developing).

However this surgery is not without its side effects – the patient also loses the ability to belch (thereby increasing bloating/flatulence) and vomit which some patients find distressing. Some encounter swallowing issues.

Transoral incisionless fundoplication (TIF) is an advanced endoscopy procedure where Dr Haidry mimics what the surgeons do but in a minimally invasive way. It is all performed via endoscope and takes less than 30 minutes.

The bottom of the food pipe is pushed into the stomach and stitched into place creating a new ‘anti reflux valve’ for the patient that prevents stomach contents leaking up. Unlike anti-reflex surgery the patient can still burp/vomit which many patients find reassuring.

TIF recovery is quick – most people are back home within 1 day and back at work within 4 days and it’s very safe, less than 0.5% patients will experience a serious problem.

Studies have shown that for up to five years after the TIF procedure, GORD symptoms are significantly reduced and around 80% of patients can stop taking daily heartburn drugs. In a recent study published from John Hopkin hospital in USA, 49 patients with LPR and evidence of GORD had the TIF procedure and experienced an improvement in their symptoms.

The TIF procedure reduces the chronic acid reflux and reduces the harm to the cell lining (which may have turned cancerous over time).


  • TIF mimics what surgeons do, but it’s completely incisionless (performed via endoscopy)
  • TIF takes around 30 minutes and doesn’t require surgery
  • TIF patients maintain normal functions such as the ability to belch and vomit
  • There is very little risk of swallowing problems (1%) after the TIF procedure


  • Surgery involves multiple incisions in the patient’s abdomen
  • Surgery takes significantly longer
  • Patients lose the ability to vomit, which some patients find distressing, and burping/belching function can be limited.
  • Surgery typically includes side effects such as difficulty swallowing (10-15%), bloating, and increased flatulence
  • Surgery is the best option for those with large hiatal hernias

Patient Review

In late 2020 I became aware of strange sensations in my throat, and across my chest. The best way I can describe this was that it felt like a prickling/creeping sensation up my throat and neck, accompanied by a strong feeling of pressure across my chest. These sensations were sometimes felt independently of one another, and I also had difficulty swallowing a few times.

I went to see my GP who sent me for an ECG, (as one symptom was chest pressure a heart attack had to be ruled out). The ECG came back clear, so I went back to my GP, but he didn’t know what was wrong. As this was during Covid I signed up to a virtual GP service, one of the doctors suspected I had chronic reflux.

This surprised me, as I didn’t have typical heartburn symptoms, however, the more reading I carried out on the unusual presentations of chronic reflux the more I thought this could be the cause. The virtual GP prescribed a PPI (Proton Pump Inhibitor) heartburn tablet, but this didn’t ease my symptoms.

I wanted to see a specialist quickly – and knew this would be impossible on the NHS – so I found a Gastroenterologist who specialises in reflux issues called Dr Rehan Haidry. He recommended an endoscopy to look at the structure of the oesophagus and a Bravo test to measure acidity levels, given I wasn’t experiencing the typical ‘burning’ sensation in my throat.

The Bravo test involves placing a tiny capsule – about the same size as a tic-tac – in the oesophagus for around 3 days to measure the levels of acid. When it came to the test I was given light sedation and a tube with a camera attached was fed down the back of my throat to implant the device and carry out the investigation. I felt a bit groggy afterwards, but I couldn’t feel the capsule, and there was no discomfort.

In recovery I was given a small device – about the same size as a Walkman – that I could wear discreetly under my jumper. The capsule in the oesophagus transmitted wireless signals to the device for around 3 days. I was instructed to press buttons on the device when I felt sensations. I also kept a written diary.

Afterwards I went back to see Dr Haidry who had reviewed the data and he explained the results to me. It showed that although I wasn’t feeling ‘heartburn’ there was a significant amount of stomach acid refluxing up my oesophagus, (particularly when I was lying down). The sphincter between my oesophagus and stomach was open wider than normal, which was likely the cause.

In order to try to resolve the problem Dr Haidry prescribed a different PPI treatment, and I put myself on a strict diet avoiding acidic foods and fatty dishes to try to reduce the acidity in my stomach. Unfortunately, these approaches did not help my symptoms.

I was concerned that doing nothing about the reflux could lead to a pre-cancerous condition called Barrett’s Oesophagus, so I began to research permanent solutions such as anti-reflux surgery. I decided to pursue TIF (trans-oral incisionless fundoplication) as Dr Haidry had advised that I would be a good candidate for this option, and it does not involve major invasive surgery.

The TIF procedure involves lengthening the oesophagus. Then the top of the stomach is folded and partially wrapped around the lower oesophagus. It is held in place with staples made of benign material which has been used inside the body for decades.

I decided to pay privately with Dr Haidry for the TIF procedure, as I still hadn’t had a first appointment with an NHS gastro, and knew it could be years before I was treated due to the backlog caused by Covid.

The procedure is done in the endoscopy suite under general anaesthetic. I stayed overnight after the operation and I did experience some pain immediately afterwards, but this was dealt with via a dose of painkillers for a few days afterwards. Also, during the surgery Dr Haidry discovered I had a hiatus hernia, the TIF surgery corrected this too.

I did struggle with the post-procedure diet. The diet consisted of clear liquid for 3 days (water, clear broth, etc), and then soups without lumps and pureed food, gradually building up to thicker textures.

I desperately wanted the surgery to be a success, and was very concerned that my symptoms may return if I didn’t follow the diet to the letter. In fact, I was very careful for far longer than recommended. It wasn’t until about 6 – 8 months later that I started to eat a more normal diet again and tried tea and coffee – which were previously huge triggers.

I can now drink tea and coffee again in moderation and I have a normal diet, it is truly amazing. Two years on I have virtually no symptoms at all. I prepare healthy balanced meals and eat out a couple of times a week. I know I have safeguarded my health and won’t develop a more serious condition like Barrett’s Oesophagus. I can’t speak more highly of Dr Haidry and I am so grateful that this procedure has given me back a normal life.

Sam, 53, Hertfordshire

Property Business Owner

22,000 TIF procedures have been carried out worldwide with minimal complications and a serious adverse event rate under 0.5%.

TIF can help eliminate general GORD symptoms including upper abdominal pain, nausea/vomiting, stomach bleeding and swallowing disorders. It can also help with “atypical” symptoms of such as worsening asthma, hoarseness, cough, chest pain, aspiration or a ‘lump in the throat’ sensation which medicines haven’t been very effective in treating.

The TIF procedure is currently available at the Cleveland Clinic Hospital in London and is covered by most private insurers.

Get In Touch

For any enquiries about conditions, tests or treatments, please feel free to call Dr Rehan Haidry’s medical secretary Debra Hyams on:

Tel: 0203 423 7609  |  Email: