American Foregut Society White Paper Provides Best Practices for Use of Newer, Less Invasive GERD Treatments
By Olaya I. Brewer Gutierrez, David Choi, Reza Hejazi, Salih Samo, Michael N. Tran, Kenneth J. Chang, Reginald Bell, and Ninh T. Nguyen
Figure 1: The TIF steps. (A) Posterior plication, (B) Anterior plication, (C) Mid-valve plication, and (D) Completed TIF valve.
A new white paper by the American Foregut Society (AFS) summarizes the published outcome data for Transoral Incisionless Fundoplication 2.0 (TIF 2.0) and Concomitant Transoral Incisionless Fundoplication (cTIF) to date and outlines the best practice approaches and patient assessment, selection, and management using TIF 2.0 and cTIF. The white paper is published online as an article in press in Foregut, the official journal of AFS and the European Foregut Society. Foregut is the only subscription journal focused exclusively on foregut disease linking medical, endoscopic, and surgical disciplines. Accompanying the manuscript is a commentary that helps put the white paper into context.
Gastrointestinal reflux disease (GERD) is one of the most common and debilitating esophageal conditions, affecting about one in five American adults. Initial treatments for the condition include lifestyle changes and medications, such as proton pump inhibitors. When those treatments fail, the next step can be anti-reflux surgery, often a procedure called fundoplication where the upper stomach is wrapped around the lower esophagus to reduce the acid that can enter the esophagus from the stomach. In addition to surgery, there are newer techniques performed endoscopically called TIF 2.0 and cTIF. These treatments are sometimes preferred because while they are more intensive than medication, they are less invasive than traditional fundoplication surgery. These newer techniques often are reported to have fewer side effects than fundoplication, such as gas-bloat syndrome and dysphagia.
Figure 2: Endoscopic view of the esophagogastric junction showing (A) a large hiatal disruption and Hill grade IV prior to surgery (B) resolution of the hiatal disruption after laparoscopic hiatal hernia repair (C) augmentation of the gastroesophageal flap valve after cTIF.
“GERD is a common disease affecting millions of patients and a leading indication for endoscopy,” said Dr. Olaya I. Brewer Gutierrez, Director of Endoscopy at Sibley Memorial Hospital in Washington, D.C., and Director of the Johns Hopkins University Heartburn Center in Baltimore, Maryland, and lead author on the paper. “To minimize the risks associated with traditional fundoplication surgery, some patients may be eligible for a non-surgical option called TIF. This white paper summarizes the published outcome data for TIF 2.0 and cTIF to date and outline the best practice approaches including patient assessment, selection, and management for TIF and cTIF.”
According to evidence presented in the white paper, for appropriately selected patients, TIF offers patients an option to improve their quality of life and treat their GERD. The paper concludes TIF is an effective solution to add to the armamentarium alongside medical management and surgical management for the treatment of GERD.
Article Details
American Foregut Society White Paper on Transoral Incisionless Fundoplication
The American Foregut Society Clinical Practice Committee TIF Working Group, Olaya I. Brewer Gutierrez, David Choi, Reza Hejazi, Salih Samo, Michael N. Tran, Kenneth J. Chang, Glenn Ihde, Reginald Bell, and Ninh T. Nguyen
First published online May 2, 2023
DOI: 10.1177/26345161231170788
Foregut: The Journal of the American Foregut Society
Invited Commentary American Foregut Society White Paper on Transoral Incisionless Fundoplication Transoral Incisionless Fundoplication: Where Are We and Where Do We Go From Here?
Nisha Narula
First published online April 26, 2023
DOI: 10.1177/26345161231170589
Foregut: The Journal of the American Foregut Society
About the Authors
Olaya I. Brewer Gutierrez, M.B.B.S., is the Director of Endoscopy at Sibley Memorial Hospital in Washington, D.C., and Director of the Johns Hopkins University Heartburn Center in Baltimore, Maryland. Dr. Brewer Gutierrez received her medical degree from the Central University of Venezuela in Caracas and completed her fellowship in therapeutic endoscopy and motility at Johns Hopkins University. She specializes in anti-reflux procedures such as transoral incisionless fundoplication (TIF), pancreatobiliary diseases, endoscopic mucosal resection, endoscopic ultrasound and endoscopic retrograde cholangiopancreatography (ERCP).
David Choi, D.O., currently practices at Larkin Community Hospital in Florida. Dr. Choi received his medical degree from A.T. Still University in Oklahoma City, Oklahoma, and completed his residency and fellowship in gastroenterology at Larkin Community Hospital in South Miami, Florida.
Reza Hejazi, M.D. is an associate professor of Gastroenterology, Hepatology, and Motility at the University of Kansas in Kansas City. He received his medical degree from the Urmia University of Medical Sciences in Iran, completed his residency at Texas Tech University Health Sciences Center in El Paso, Texas, and his clinical fellowship in gastroenterology at the Mayo Clinic in Jacksonville, Florida. Dr. Hejazi’s clinical interests include Barrett's esophagus, radiofrequency ablation (RFA), cryotherapy, GERD, and motility disorders.
Salih Samo, M.D., MSci, is an assistant professor of Gastroenterology, Hepatology, and Motility at the University of Kansas in Kansas City. He received his medical degree from the University of Aleppo in Syria and received a Master of Clinical Science Investigations (MSCI) degree from Northwestern University Feinberg School of Medicine in Chicago. He completed his residency at Presence St. Francis Hospital in Illinois and finished a fellowship in digestive diseases at Emory University School of Medicine in Atlanta. His clinical interests are in esophageal and foregut disorders including esophageal motility disorders, GERD, eosinophilic esophagitis, and other swallowing disorders.
Michael N. Tran, M.D., is the assistant clinical professor of surgery at the University of California Irvine. Dr. Tran received his medical degree from the University of Wisconsin School of Medicine and Public Health. He completed his general surgery residencies at Rush University in Chicago, Illinois, and at Anne Arundel Medical School in Maryland. Afterward, he finished a fellowship in advanced GI and minimally invasive surgery at the University of California Irvine. He specializes is foregut, heartburn and reflux, and bariatric surgery.
Kenneth Chang, M.D., is the executive director of the University of California Irvine Health Digestive Health Institute with clinical research interests in the development of endoscopic modalities for cancer diagnosis, staging and therapy. Dr. Chang completed his medical degree at Brown University in Providence, R.I. He then finished a fellowship in gastroenterology at UCI Medical Center and the UCI School of Medicine, where he has been a faculty member for more than 25 years. He holds the Vincent Kong Chair of Gastrointestinal Oncology and serves as chief of the medical school's Division of Gastroenterology and Hepatology.
Ninh Nguyen, M.D., is a gastroenterological surgery specialist in Orange, California, and has more than 33 years of experience in the medical field. He graduated from University of Texas Medical School at San Antonio and is affiliated with UCI Medical Center. Dr. Nguyen’s clinical specialties include bariatric surgery, gastrointestinal cancer services, digestive disease services, esophageal disease services, surgical oncology services, minimally invasive surgery, and robotic oncology services.
Reginald C.W. Bell, M.D., is the founder of the Institute of Esophageal and Reflux Surgery in Lone Tree, Colorado, a part of SOFI Research, LLC. Dr. Bell has practiced for more 30 years and has extensive experience performing minimally invasive procedures on the esophagus and stomach. Dr. Bell received his medical degree in 1985 from Virginia Commonwealth University in Richmond, Virginia. He is currently the president of the American Foregut Society, a specialty society guiding and fostering collaboration between gastroenterologists and foregut surgeons in the treatment of foregut disease.