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CC BY-NC-ND 4.0 · Endosc Int Open 2024; 12(01): E43-E49
DOI: 10.1055/a-2215-3415
Original article

Transoral incisionless fundoplication with or without hiatal hernia repair for gastroesophageal reflux disease after peroral endoscopic myotomy

John M. DeWitt 
1   Gastroenterology and Hepatology, Indiana University Health Inc, Indianapolis, United States (Ringgold ID: RIN22529)
,
Mohammad Al-Haddad 
1   Gastroenterology and Hepatology, Indiana University Health Inc, Indianapolis, United States (Ringgold ID: RIN22529)
,
Sarah Stainko
1   Gastroenterology and Hepatology, Indiana University Health Inc, Indianapolis, United States (Ringgold ID: RIN22529)
,
Anthony Perkins
2   Biostatistics, Indiana University Health Inc, Indianapolis, United States (Ringgold ID: RIN22529)
,
Hala Fatima
1   Gastroenterology and Hepatology, Indiana University Health Inc, Indianapolis, United States (Ringgold ID: RIN22529)
,
DuyKhanh P. Ceppa
1   Gastroenterology and Hepatology, Indiana University Health Inc, Indianapolis, United States (Ringgold ID: RIN22529)
,
Thomas J. Birdas
3   Department of Surgery, Division of Cardiothoracic Surgery, Indiana University Health Inc, Indianapolis, United States (Ringgold ID: RIN22529)
› Author Affiliations TRIAL REGISTRATION: Registration number (trial ID): NCT04306380, Trial registry: ClinicalTrials.gov (http://www.clinicaltrials.gov/), Type of Study: Prospective, cohort study
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Abstract

Background and study aims Gastroesophageal reflux disease (GERD) following peroral endoscopic myotomy (POEM) occurs in 40% to 60% of patients. There are limited data evaluating antireflux surgery or transoral incisionless fundoplication (TIF) for refractory post-POEM GERD.

Patients and methods In a single-center prospective cohort study, consecutive patients with medically refractory post-POEM regurgitation and/or GERD treated with TIF or combined laparoscopic hernia repair and TIF (cTIF) were evaluated. Baseline evaluation: GERD-Health Related Quality of Life (GERD-HQRL) and Reflux Symptom Questionnaire 7-day recall (RESQ-7) questionnaires, EGD, high-resolution manometry (HRM), 48-hour pH test off proton pump inhibitors (PPIs) and impedance planimetry of the esophagogastric junction (EGJ) to calculate the diameter distensibility index (EGJ-DI). A PPI was taken twice daily for 2 weeks after TIF and restarted later if required. Patients returned 9 to 12 months after treatment when all preoperative studies were repeated. Quality of life, pH studies and EGJ metrics before and after antireflux surgery were compared.

Results Seventeen patients underwent TIF (n=2, 12%) or cTIF (n=15, 88%) a mean 25±15 months after POEM. At follow-up a mean of 9±1 months after TIF/cTIF, patients required less frequent daily PPIs (n=0.001), were more satisfied (P=0.008), had improved GERD-HQRL (P=0.001), less intensity and frequency of GERD (P=0.001) and fewer reflux episodes (P=0.04) by pH testing. There was no change in EGJ-DI, EGJ diameter, integrated relaxation pressure, % total time pH <4, or DeMeester score.

Conclusions TIF and cTIF for difficult-to-control post-POEM GERD appear safe, decrease PPI use and reflux episodes, and improve QOL without significant change in IRP, EGJ compliance, diameter or esophageal acid exposure time.

Keywords

Reflux disease - Motility / achalasia - POEM


Publication History

Received: 15 September 2023

Accepted after revision: 16 November 2023

Accepted Manuscript online:
21 November 2023

Article published online:
05 January 2024

© 2024. 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 commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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