Is transoral incisionless fundoplication (TIF) an answer to post-peroral endoscopic myotomy gastroesophageal reflux? A multicenter retrospective study.

Background: The use of peroral endoscopic myotomy (POEM) for achalasia has a high incidence of post-procedural gastroesophageal reflux (GER). Transoral incisionless fundoplication (TIF) may be an ideal endoscopic treatment. We report our experience with the use of post-POEM TIF.
Methods: In this multicenter retrospective study, post-POEM patients with GER who underwent TIF were included. The study end points were: (i) technical success; (ii) safety; (iii) effectiveness (changes in symptoms, scores, proton pump inhibitor [PPI] use, pH studies).
Results: 12 patients underwent TIF after POEM, nine of whom had daily symptoms, with 91.7% requiring twice daily (BID) PPIs. Technical success was achieved in all patients. Two adverse events occurred. There were significant decreases in the percentage of patients on BID PPIs ( P = 0.03), frequency of daily symptoms ( P = 0.03), Reflux Severity Index questionnaire, and GERD Health-related Quality of Life scores ( P = 0.03 and P = 0.003; n = 6). pH studies performed in seven of the patients showed a significant reduction in the mean DeMeester score ( P = 0.05) and mean percentage acid exposure time ( P = 0.04).
Conclusion: Our experience suggests that TIF may be effective and safe in treating GER after POEM. Larger prospective trials are needed.
Competing Interests: Kenneth J. Chang has served as a consultant for Apollo Endosurgery, Cook, Erbe, Endo-Gastric solutions, Mauna Kea, Mederi, Medtronics, Olympus, Ovesco, and Pentax. Petros C. Benias is a consultant for Medtronic. Marcia Irene Canto is a consultant for Pentax Medical/C2 Therapeutics. Mouen A. Khashab is a consultant for Boston Scientific, Medtronic, and Olympus. The remaining authors declare that they have no conflict of interest.
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