Transoral Incisionless fundoplication for reflux after peroral endoscopic myotomy: a crucial addition to our arsenal
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)...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Georg Thieme Verlag KG
2018-05-01
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| Series: | Endoscopy International Open |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/a-0584-6802 |
| _version_ | 1818159333434720256 |
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| author | Amy Tyberg Anthony Choi Monica Gaidhane Michel Kahaleh |
| author_facet | Amy Tyberg Anthony Choi Monica Gaidhane Michel Kahaleh |
| author_sort | Amy Tyberg |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-11T15:44:19Z |
| format | Article |
| id | doaj.art-41a1849e68e74344aa8e440d44af5d58 |
| institution | Directory Open Access Journal |
| issn | 2364-3722 2196-9736 |
| language | English |
| last_indexed | 2024-12-11T15:44:19Z |
| publishDate | 2018-05-01 |
| publisher | Georg Thieme Verlag KG |
| record_format | Article |
| series | Endoscopy International Open |
| spelling | doaj.art-41a1849e68e74344aa8e440d44af5d582022-12-22T00:59:43ZengGeorg Thieme Verlag KGEndoscopy International Open2364-37222196-97362018-05-010605E549E55210.1055/a-0584-6802Transoral Incisionless fundoplication for reflux after peroral endoscopic myotomy: a crucial addition to our arsenalAmy Tyberg0Anthony Choi1Monica Gaidhane2Michel Kahaleh3Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ USA Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ USA Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ USA Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ USA 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.http://www.thieme-connect.de/DOI/DOI?10.1055/a-0584-6802 |
| spellingShingle | Amy Tyberg Anthony Choi Monica Gaidhane Michel Kahaleh Transoral Incisionless fundoplication for reflux after peroral endoscopic myotomy: a crucial addition to our arsenal Endoscopy International Open |
| title | Transoral Incisionless fundoplication for reflux after peroral endoscopic myotomy: a crucial addition to our arsenal |
| title_full | Transoral Incisionless fundoplication for reflux after peroral endoscopic myotomy: a crucial addition to our arsenal |
| title_fullStr | Transoral Incisionless fundoplication for reflux after peroral endoscopic myotomy: a crucial addition to our arsenal |
| title_full_unstemmed | Transoral Incisionless fundoplication for reflux after peroral endoscopic myotomy: a crucial addition to our arsenal |
| title_short | Transoral Incisionless fundoplication for reflux after peroral endoscopic myotomy: a crucial addition to our arsenal |
| title_sort | transoral incisionless fundoplication for reflux after peroral endoscopic myotomy a crucial addition to our arsenal |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/a-0584-6802 |
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