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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. May 6, 2016; 7(2): 179-189
Published online May 6, 2016. doi: 10.4292/wjgpt.v7.i2.179
Transoral incisionless fundoplication for gastro-esophageal reflux disease: Techniques and outcomes
Pier Alberto Testoni, Giorgia Mazzoleni, Sabrina Gloria Giulia Testoni
Pier Alberto Testoni, Giorgia Mazzoleni, Sabrina Gloria Giulia Testoni, Division of Gastroenterology and Gastrointestinal Endoscopy, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, 20132 Milan, Italy
Author contributions: Testoni PA, Mazzoleni G and Testoni SGG equally contributed to this paper with regard to conception and design of the study, literature review, analysis and interpretation of data, drafting the article and making critical revisions related to important intellectual content of the manuscript; Testoni PA contributed to final approval of the version of the article to be published.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Pier Alberto Testoni, MD, Division of Gastroenterology and Gastrointestinal Endoscopy, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, via Olgettina 58, 20132 Milan, Italy. testoni.pieralberto@hsr.it
Telephone: +39-2-26432756 Fax: +39-2-26433491
Received: October 17, 2015
Peer-review started: October 17, 2015
First decision: November 24, 2015
Revised: December 24, 2015
Accepted: February 23, 2016
Article in press: February 24, 2016
Published online: May 6, 2016
Processing time: 186 Days and 22.2 Hours
Abstract

Gastro-esophageal reflux disease (GERD) is a very common disorder that results primarily from the loss of an effective antireflux barrier, which forms a mechanical obstacle to the retrograde movement of gastric content. GERD can be currently treated by medical therapy, surgical or endoscopic transoral intervention. Medical therapy is the most common approach, though concerns have been increasingly raised in recent years about 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 too may in some cases have consequences such as long-lasting dysphagia, flatulence, inability to belch or vomit, diarrhea, or functional dyspepsia related to delayed gastric emptying. In the last few years, transoral incisionless fundoplication (TIF) has proved an effective and promising therapeutic option as an alternative to medical and surgical therapy. This review describes the steps of the TIF technique, using the EsophyX® device and the MUSETM system. Complications and their management are described in detail, and the recent literature regarding the outcomes is reviewed. TIF reconfigures the tissue to obtain a full-thickness gastro-esophageal valve from inside the stomach, by serosa-to-serosa plications which include the muscle layers. To date the procedure has achieved lasting improvement of GERD symptoms (up to six years), cessation or reduction of proton pump inhibitor medication in about 75% of patients, and improvement of functional findings, measured by either pH or impedance monitoring.

Keywords: Gastro-esophageal reflux disease; Transoral incisionless fundoplication; Anterior fundoplication with ultrasonic surgical endostapler; EsophyX; MUSE; Surgical fundoplication

Core tip: Transoral incisionless fundoplication (TIF) has recently emerged as an effective and promising therapeutic option in alternative to medical and surgical therapy for gastro-esophageal reflux disease (GERD). A number of prospective observational studies for TIF using the EsophyX® device have been published but there is still only limited data for TIF with the MUSETM system. This review describes the techniques for TIF with both these devices, and is intended to consolidate the current literature, clarifying better the outcomes of TIF in patients with GERD.