Transoral incisionless fundoplication
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| specialty = Gastroenterology
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Transoral incisionless fundoplication (TIF) is an endoscope treatment designed to relieve symptoms of gastroesophageal reflux disease (GERD). The TIF procedure, similar to Nissen fundoplication, alleviates GERD symptoms by wrapping a portion of the stomach around the esophagus.{{Cite web|url=http://www.physiciansweekly.com/is-it-gerd-recognizing-atypical-symptoms/|title=Is It GERD? Recognizing Atypical Symptoms {{!}} Physician's Weekly for Medical News, Journals & Articles|website=www.physiciansweekly.com|date=16 May 2017 |language=en-US|access-date=2017-05-18}}
The TIF procedure, unlike laparoscopic fundoplication, does not require surgical incisions. Instead a surgical device (called the EsophyX) is inserted into the mouth, passed through the throat, and into the stomach. An endoscope is utilized to perform the procedure.{{Cite web|url=http://www.mddionline.com/article/gerd-device-maker-uses-clinical-data-prove-its-point-03-11-15|title=GERD Device Maker Uses Clinical Data to Prove Its Point {{!}} MDDI Medical Device and Diagnostic Industry News Products and Suppliers|website=www.mddionline.com|language=en|access-date=2017-05-18|date=2015-03-12}}
A minority of individuals who undergo the TIF procedure also require a hiatal hernia repair operation.{{Cite news|url=http://www.mcall.com/news/local/easton/mc-easton-hospital-acid-reflux-fix-20161002-story.html|title=New Easton Hospital procedure fixes heartburn|last=Kennedy|first=Sam|work=themorningcall.com|access-date=2017-06-06|language=en-US}} The procedure is performed while the person is under general anesthesia{{Cite web|url=http://www.mcw.edu/General-Surgery/Patient-Info/GERD-Surgery-Program/Reflux-Disease/TIF.htm|title=MCW: Endoscopic Transoral Incisionless Fundoplication|website=www.mcw.edu|language=en|access-date=2017-05-18}} and is typically an outpatient procedure.
Medical use
Transoral incisionless fundoplication may improve symptoms in gastroesophageal reflux disease, at least in the short term. Benefits from the TIF procedure may last for up to 6 years.{{Cite journal|last1=Hopkins|first1=Jessica|last2=Switzer|first2=Noah J|last3=Karmali|first3=Shahzeer|date=2015-08-25|title=Update on novel endoscopic therapies to treat gastroesophageal reflux disease: A review|journal=World Journal of Gastrointestinal Endoscopy|volume=7|issue=11|pages=1039–1044|doi=10.4253/wjge.v7.i11.1039|issn=1948-5190|pmc=4549661|pmid=26322157 |doi-access=free }}
Complications
The risk of severe complications is 2.4%.{{cite journal |last1=Nabi |first1=Z |last2=Reddy |first2=DN |title=Update on Endoscopic Approaches for the Management of Gastroesophageal Reflux Disease. |journal=Gastroenterology & Hepatology |date=July 2019 |volume=15 |issue=7 |pages=369–376 |pmid=31391807|pmc=6676348 }} About 1 in 30 people have major complications from the procedure.{{cite journal|last1=Wendling|first1=MR|last2=Melvin|first2=WS|last3=Perry|first3=KA|title=Impact of transoral incisionless fundoplication (TIF) on subjective and objective GERD indices: a systematic review of the published literature.|journal=Surgical Endoscopy|date=October 2013|volume=27|issue=10|pages=3754–61|pmid=23644835|doi=10.1007/s00464-013-2961-0|s2cid=12729228 }}
History
The device utilized to perform the procedure, called EsophyX, was developed by EndoGastric Solutions. The first TIF procedure utilizing the device was performed in 2005.{{Cite journal|last=Sami Trad|first=Karim|date=2017-05-10|title=Transoral incisionless fundoplication: current status|journal=Current Opinion in Gastroenterology|volume=32|issue=4|pages=338–343|doi=10.1097/MOG.0000000000000275|issn=0267-1379|pmc=4894777|pmid=27023164}} The device received European Union CE mark in 2006 and United States Food and Drug Administration issued initial 510(k) clearance in 2007.{{Cite news|url=http://www.mlive.com/living/kalamazoo/index.ssf/2010/02/incision-free_surgery_treats_a.html|title=Incision-free surgery treats acid reflux: Allegan surgeon is training other doctors to do the procedure|work=MLive.com|access-date=2017-05-10|language=en-US}}
In February 2015, the American Medical Association's CPT Editorial Panel reviewed whether to create a new category 1 current procedural terminology (CPT) code for the TIF procedure. In January 2016, a unique code for the transoral incisionless fundoplication procedure was created and implemented.{{Cite web|url=http://www.healio.com/gastroenterology/interventional-endoscopy/news/online/%7B9d3ee93a-6b5d-4be4-96e8-6f82fe4f86df%7D/ama-creates-cpt-code-for-transoral-incisionless-fundoplication-procedure-for-gerd|title=AMA creates CPT code for transoral incisionless fundoplication procedure for GERD|website=www.healio.com|language=en|access-date=2017-06-06}}
As of 2016, more than 17,000 TIF procedures had been performed.
In July 2016, Health Care Service Corporation (HCSC) became the first United States health insurance company to add the TIF procedure to their medical coverage policy. HSCS added the TIF procedure to their health insurance policy at the recommendation of both the American Gastroenterological Association (AGA) and The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES).{{Cite news|url=http://www.myplainview.com/news/article/TIF-procedure-for-reflux-now-covered-by-Blue-9965264.php|title=TIF procedure for reflux now covered by Blue Cross Blue Shield of Texas|work=Plainview Daily Herald|access-date=2017-05-10}}
Other options
The TIF procedure is not the ideal GERD solution for all people. Other medical and endoscopic treatments to alleviate GERD symptoms include: Stretta procedure{{Cite journal|last1=Hopkins|first1=Jessica|last2=Switzer|first2=Noah J.|last3=Karmali|first3=Shahzeer|date=2015-08-25|title=Update on novel endoscopic therapies to treat gastroesophageal reflux disease: A review|journal=World Journal of Gastrointestinal Endoscopy|volume=7|issue=11|pages=1039–1044|doi=10.4253/wjge.v7.i11.1039|pmc=4549661|pmid=26322157 |doi-access=free }} and proton-pump inhibitors (PPIs).{{Cite journal|last1=Trad|first1=Karim S.|last2=Barnes|first2=William E.|last3=Simoni|first3=Gilbert|last4=Shughoury|first4=Ahmad B.|last5=Mavrelis|first5=Peter G.|last6=Raza|first6=Mamoon|last7=Heise|first7=Jeffrey A.|last8=Turgeon|first8=Daniel G.|last9=Fox|first9=Mark A.|date=2017-05-15|title=Transoral Incisionless Fundoplication Effective in Eliminating GERD Symptoms in Partial Responders to Proton Pump Inhibitor Therapy at 6 Months|journal=Surgical Innovation|volume=22|issue=1|pages=26–40|doi=10.1177/1553350614526788|issn=1553-3506|pmc=4361451|pmid=24756976}}