TIF / EsophyX®
What Is a TIF or EsophyX® procedure?
Transoral Incisionless Fundoplication, or TIF, is an endoscopic surgery used to reconstruct a patient’s injured or weakened lower esophageal sphincter valve in order to restore the reflux barrier. TIF is an alternative to standard laparoscopic or robotic surgery for people who require an anatomical alteration to correct the underlying cause of GERD. It is performed entirely through the mouth utilizing the EsophyX® device without the need for external skin incisions. While it is similar to a laparoscopic or robotic fundoplication, TIF is a much less invasive method of creating a partial fundoplication.
As with all reflux patients considering surgical options, a thorough workup that confirms an abnormal amount of reflux is required.Patients with typical reflux symptoms always respond better to all anti-reflux procedures and surgeries.
Patients that meet the following criteria have the best outcomes utilizing the TIF procedure:
- BMI <30
- < 2 cm hiatal hernia
- no plans for future pregnancies
TIF is the most effective endoscopic antireflux procedure.
There are no incisions.
Common anti-reflux surgery adverse effects, such as dysphagia and bloating, are mild.
Around 70% of patients are able to stop daily usage of antacid medications.
Any other anti-reflux operation can be performed if necessary in the future. No bridges are burned.
TIF is a fantastic choice for many people with mild to moderate GERD, but as with every treatment, it has its drawbacks:
TIF as a partial fundoplication surgery is not as effective as a complete Nissen fundoplication or LINX procedure
TIF should only be offered to a highly selective population that have normal BMI, minimal hiatal hernia and mild to moderate reflux.
Similar to LINX, the long-term durability cannot be accurately assessed until more time passes.
The Transoral Incisionless fundoplication is an outpatient procedure. Patients are prescribed preventative anti-nausea medication due to the fact that vomiting or retching soon after surgery weakens the operation decreasing its effectiveness. Patients are placed on a liquid diet for two weeks after surgery and on a semi-solid diet for weeks 3 and 4. Restrictions are then removed between weeks 4 and 6. Patients are weaned off their daily antacids after the initial 2-week period. Patients are advised to take 5-7 days leave from work to recover and have a weight lifting restriction >20 pounds for 6 weeks after surgery. Patients are able to address all discomfort with Tylenol and over the counter anti-inflammatory medications after the procedure.