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Tyberg A, Choi A, Gaidhane M, et al. Transoral incisional fundoplication for reflux after peroral endoscopic myotomy: a crucial addition to our arsenal. Endosc Int Open. 2018;6(5):E549-E552doi: 10.1055/a-0584-6802.
Tyberg, A., Choi, A., Gaidhane, M., & Kahaleh, M. (2018). Transoral incisional fundoplication for reflux after peroral endoscopic myotomy: a crucial addition to our arsenal. Endoscopy international open, 6(5), E549-E552. https://doi.org/10.1055/a-0584-6802
Tyberg, Amy, et al. "Transoral incisional fundoplication for reflux after peroral endoscopic myotomy: a crucial addition to our arsenal." Endoscopy international open vol. 6,5 (2018): E549-E552. doi: https://doi.org/10.1055/a-0584-6802
Tyberg A, Choi A, Gaidhane M, Kahaleh M. Transoral incisional fundoplication for reflux after peroral endoscopic myotomy: a crucial addition to our arsenal. Endosc Int Open. 2018 May;6(5):E549-E552. doi: 10.1055/a-0584-6802. Epub 2018 May 08. PMID: 29756011; PMCID: PMC5943699.
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Endosc Int Open. 2018 May;6(5):E549-E552. doi: 10.1055/a-0584-6802. Epub 2018 May 08.

Transoral incisional fundoplication for reflux after peroral endoscopic myotomy: a crucial addition to our arsenal.

Endoscopy international open

Amy Tyberg, Anthony Choi, Monica Gaidhane, Michel Kahaleh

Affiliations

  1. Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ USA.

PMID: 29756011 PMCID: PMC5943699 DOI: 10.1055/a-0584-6802

Abstract

INTRODUCTION:  Increased esophageal acid exposure is seen in a large percentage of patients with achalasia who undergo peroral endoscopic myotomy (POEM). Endoscopic transoral fundoplication (TIF) is a novel endoscopic technique for the management of patients with chronic gastroesophageal reflux (GERD). We present the first case series evaluating the role of TIF post-POEM.

METHODS:  Consecutive patients 18 years or older from our academic institution who underwent a POEM procedure and subsequently underwent TIF for symptomatic reflux or regurgitation between December 2014 and June 2017 were included. The primary outcome was discontinuation of proton-pump inhibitor (PPI) use and healing of esophagitis (when initially present) on post-procedure esophagogastroduodenoscopy (EGD). Technical success was defined as successful completion of the endoscopic fundoplication. Adverse events (AEs) were recorded for all patients.

RESULTS : Five patients were included (60 % male, average age 55 ± 14 years). Technical success was achieved in 100 % of patients. Discontinuation of PPI use was achieved in 5/5 patients (100 %). Three patients had esophagitis pre-procedure and all were noted to have resolution of inflammation on post-procedure EGD. No adverse events were noted. Mean follow-up time was 27 months (range 5 - 34 months).

CONCLUSION:  TIF post-POEM appears feasible, safe, and efficacious in improving symptoms and esophagitis, decreasing long-term risks of acid exposure, and decreasing risks of long-term PPI use in patients post-POEM in this small cohort of patients. Larger studies are needed to confirm these initial findings.

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