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CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(02): E239-E246
DOI: 10.1055/a-1322-2209
Review

Long-term outcomes of transoral incisionless fundoplication for gastro-esophageal reflux disease: systematic-review and meta-analysis

Sabrina Testoni‡
1   Division of Pancreatico-Biliary Endoscopy & Endosonography, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, Milan, Italy
,
Cesare Hassan‡
2   Ospedale Nuovo Regina Margherita, Digestive Endoscopy Unit, Rome, Italy
,
Giorgia Mazzoleni
3   Ospedale di Treviglio – Caravaggio, ASST Bergamo Ovest, Digestive Endoscopy Unit, Bergamo, Italy
,
Giulio Antonelli
2   Ospedale Nuovo Regina Margherita, Digestive Endoscopy Unit, Rome, Italy
,
Lorella Fanti
4   Division of Gastroenterology & Gastrointestinal Endoscopy, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy
,
Sandro Passaretti
4   Division of Gastroenterology & Gastrointestinal Endoscopy, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy
,
Loredana Correale
5   Im3D Clinic Piemonte S.c.a.r.l., Medical Imaging Lab, Torino, Italy
,
Giulia Martina Cavestro
4   Division of Gastroenterology & Gastrointestinal Endoscopy, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy
,
Pier Alberto Testoni
4   Division of Gastroenterology & Gastrointestinal Endoscopy, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy
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Abstract

Background and study aims Few reports exist about long-term outcomes of transoral incisionless fundoplication (TIF) for treating refractory gastro-esophageal reflux disease (GERD).

Methods A literature search of four major scientific databases was performed up to May 2020 for studies reporting on more than 3-year outcomes of TIF. Data on atient satisfaction, proton pump inhibitor (PPI) daily consumption, PPI use reduction, GERD health-related quality-of-life (GERD-HRQL) score, and normalization of heartburn and regurgitation scores were pooled and summarized with forest plots. Publication bias and heterogeneity were explored.

Results Overall, eight studies (418 patients, 232 men; 55.5 %) with a mean follow-up of 5.3 years (range: 3–10 years) were included. The pooled proportion of patient-reported satisfaction before and after TIF was 12.3 % (95 % CI:12.3–35.1 %, I2 = 87.4 %) and 70.6 % (95 % CI:51.2–84.6, I2 = 80 %), respectively, corresponding to an odds ratio of 21.4 (95 % CI:3.27–140.5). Pooled rates of patients completely off PPIs and on occasional PPIs were 53.8 % (95 %CI: 42.0 %-65.1 %) and 75.8 % (95 %CI: 67.6–82.6), respectively. The pooled estimated mean GERD-HRQL scores off PPI before and after TIF werey 26.1 (95 %CI: 21.5–30.7; range: 20.0–35.5) and 5.9, respectively (95 %CI:0.35.1–11.4; range: 5.3–9.8; P < 0.001). The overall pooled rates of heartburn and regurgitation scores normalization were 73.0 % (95 %CI: 0.62–0.82) and 86 %, respectively (95 %CI: 75.0–91.0 %).

Conclusion Our study shows that TIF appears to offer a long-term safe therapeutic option for selected patients with GERD who refuse life-long medical therapy or surgery, are intolerant to PPIs, or are at increased surgical risk.

Supplementary material



Publication History

Received: 15 July 2020

Accepted: 20 October 2020

Article published online:
03 February 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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