P2752 - Factors Influencing Outcomes of Transoral Incisionless Fundoplication (TIF): A Tertiary Center Experience

Tuesday, October 26, 2021

10:30 AM – 4:00 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Award: Presidential Poster Award

Presenting Author(s)

Sajjadh MJ Ali, MD

Saint Vincent Hospital
Worcester, MA, United States

Award: Presidential Poster Award

Sajjadh MJ Ali, MD¹, Marc F. Catalano, MD, FACG²
¹Saint Vincent Hospital, Worcester, MA; ²University of Texas Health Science Center at Houston, Houston, TX

Introduction: Gastroesophageal reflux disease (GERD) is the most prevalent gastrointestinal disorder in the United States and has been associated with esophagitis, metaplasia and adenocarcinoma. TIF involves the use of an endoscopic device to create full thickness serosa-serosa plications and reconstruct valves to prevent GERD. This study describes our experience with TIF including the use of a pre-procedure 60 French Savory guidewire dilator and fasteners during the procedure.

Methods: Retrospective chart review of 108 patients who underwent TIF in a tertiary academic center between 2016 and 2020 was done. 104 patients were included in the study. Procedure was aborted in 4 patients because TIF device could not be advanced. GERD symptoms were reassessed after a minimum of 6 months. Modified Likert scale and antisecretory medication use was used to assess symptoms pre and post procedure. Variables including intraoperative factors such as pre procedure dilation, number of fasteners deployed were analyzed using correlation and logistic regression analysis.

Results: Demographics included 60% female and 39% male. Mean age was 44.1 years (23-66). Concomitant hernia repair was performed in 16% patients. 64% patients had moderate, and 35% had severe GERD as per Likert scale pre-procedure. 78% patients had no symptoms while 15% had mild, and 7% had moderate symptoms post procedure. PPI use pre-procedure was once daily in 76% patients and twice daily in 21% patients. 85% patients reported no PPI use post procedure. 35.6% patients had pre-procedure dilation with prolonged placement of a 60 French Savory guidewire dilator. Pre procedure dilation was more likely associated with low resistance in TIF device insertion (p=0.00). Mean number of fasteners deployed was 24.5 (18-32). The number of fasteners deployed negatively correlated with post procedure PPI use (p=0.01). 48% patients were discharged the same day.

Discussion: All patients who had pre-procedure dilation had completion of TIF, while 4 patients who did not have prolonged dilation were unable to have placement of device and procedure was aborted. In addition, pre procedure dilation was associated with lower resistance in device insertion. The number of fasteners deployed negatively correlated with post procedure PPI use. We suggest pre procedure dilation and higher number of deployed fasteners may have better outcomes, although larger studies are needed. TIF can be safely performed in our experience as our patient population did not report complications.

Characteristic	Number of patients
Mean Age	44.1 years (23-66 years)
Gender	Male 41 (39.4%), Female 63 (60.6%)
Race	White 77 (74%), Black 11(10.6%), Asian 5 (4.8%), Hispanic 11 (10.6%)
Concomitant hiatal hernia repair	17 (16.3%)
Pre procedure GERD Likert scale	Severe 67 (64.4%), Moderate 37 (35.6%)
Post procedure GERD Likert scale	None 81 (77.9%), Mild 16(15.4%), Moderate 7 (6.7%)
PPI use pre procedure	Once daily- 79 (76%), twice daily-22 (21.2%), H2 blockers -3 (2.9%)
PPI use post procedure	No use 88 (84.6%), PPI use 16 (15.3%)
Dilation prior to TIF device	37 (35.6%)
Resistance during TIF device insertion	Low 29 (27.9%), Medium 43(41.3%), High 32 (30.8%)
Pre-TIF dilation and TIF Device insertion resistance	Associated with Low (p=0.00) and Medium resistance(p=0.03) compared to high resistance.
Patient Admission	Discharged same day 48 (46.2%), admitted 56 (53.8%)
Number of fasteners used	Mean 24.5 (18-32)
Number of fasteners and post PPI use	Negative correlation (p=0.01)

Table: Table 1. Factors influencing outcomes of Transoral Incisionless Fundoplication

Disclosures:

Sajjadh MJ Ali indicated no relevant financial relationships.

Marc F. Catalano indicated no relevant financial relationships.

Sajjadh MJ Ali, MD¹, Marc F. Catalano, MD, FACG². P2752 - Factors Influencing Outcomes of Transoral Incisionless Fundoplication (TIF): A Tertiary Center Experience, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.