Transoral Incisionless Fundoplication (TIF)

A Surgical Solution for Heartburn Without Incisions – “Transoral Incisionless Fundoplication

What may have seemed like science fiction, surgery without an incision, is now a reality that is giving back patients suffering from chronic acid reflux or gastroesophageal reflux disease (GERD) a normal life. Dr. Haidry at the LGC is now offering the TIF procedure for the treatment of GERD. He was the first endoscopist in Europe to perform the TIF 2.0 procedure and has the most experience with this new procedure in Europe having carried out the most cases.

In a healthy patient, there is a natural valve between the esophagus and the stomach that forms a physical barrier preventing stomach fluids from backwashing, or “refluxing,” up into the esophagus. In a patient with chronic GERD, this valve has become dysfunctional.

Many patients take reflux medications such as PPIs (proton pump inhibitors), which suppress acid production, to help relieve their heartburn symptoms. Even with PPIs, they are still unable to eat the foods they want or need to sleep sitting up to reduce nighttime reflux. In addition, recent studies have shown that long-term use of PPIs is linked to inadequate absorption of minerals1, chronic kidney disease2 and dementia3. GERD sufferers just want to get back to living normal lives.

Most patients treat their GERD with OTC or Rx medications—most frequently proton pump inhibitors (PPIs). For some patients, these medications don’t adequately control symptoms or may stop working after extended use. These patients are considered refractory to PPIs. Other patients are uncomfortable with side-effects and long-term dependence. Patients are increasingly uncomfortable with traditional anti-reflux surgery (ARS). The treatment gap for GERD patients refractory to PPIs is significant. Patients are interested in a procedure that improves symptom control and reduces medication dependence.
TIF is an acronym, transoral incisionless fundoplication, and the advantage is that it is ‘surgery from within’ performed through the mouth. Based on the same well proven principles of conventional, more invasive laparoscopic GERD surgery, the TIF procedure reconstructs the valve between the esophagus and the stomach to prevent reflux. Because the procedure is incisionless, there is reduced pain, no visible scar and most patients can get back to their normal activities within a few days.

The TIF procedure restores the integrity of the gastroesophageal valve, the natural barrier to reflux, by creating, internally, a 270-degree Oesophagogastric wrap around the distal esophagus, anchored by multiple polypropylene fasteners. The procedure is performed through the mouth with flexible, tube-like instrument, called the EsophyX Z+ device which holds the gastroscope for the vision.

Who can benefit from TIF?

  • Patients with typical acid reflux symptoms (GORD) and sub-optimal control of their symptoms on PPIs who do not have a large hiatal hernia (<3cm) or oesophageal motility problems
  • Patients with GORD symptoms and mild to moderate anatomic abnormalities of the gastroesophageal junction valve function that require correction
  • Patients preferring an alternative management strategy for their GORD that does not involve long-term medication use
The TIF can be advised instead of surgical Nissen fundoplication to avoid the unwanted side effects that Nissen fundoplication may produce, including:

  • Trouble swallowing
  • Difficulty eating for several months
  • Trapped air resulting in belching or bloating
  • Hernia at the incision location
TRANSORAL INCISIONLESS FUNDOPLICATION – the TIF procedure, fills the refractory GERD treatment gap. Using an endoscopic approach – similar to diagnostic EGD – the gastroesophageal valve (GEV) is reconstructed without incisions following principles of traditional fundoplication. The TIF procedure maintains an exemplary safety profi e with minimal side-effects.
The TIF procedure with the EsophyX device can significantly improve quality of life for patients. Clinical studies show that at three years after the TIF procedure 70% were able to completely stop PPI therapy, reflux esophagitis healed in 87% of patients and 91% of patients reported elimination of troublesome regurgitation. Reflux no longer impacts their life like it previously did. With millions of patients diagnosed with GERD and not fully satisfied with their treatment options, the TIF procedure with the EsophyX device offers an excellent alternative. We are very excited to be able to offer our patients the same benefits as more invasive surgery with minimal risk with this new innovative procedure.

Please contact the London Gastroenterology Centre if you or someone you know suffers with chronic GERD and would like more information about how the TIF procedure can get you back to living without the pills and without heartburn.

  1. http://www.fda.gov/drugs/drugsafety/informationbydrugclass/ucm213259.htm
  2. Lazarus B, et. al., JAMA Intern Med. 2016 Feb 1;176(2):238-46.
  3. Gomm W et. al., JAMA Neurol. 2016 Feb 15. doi: 10.1001/jamaneurol.2015.4791.

To make an enquiry or appointment please contact Dr Rehan Haidry's secretary