The Transoral Incisionless Fundoplication (TIF) procedure is an endoscopic treatment for people with refractory gastro-oesophageal reflux disease.

Reflux can occur when the muscle/valve that keeps the contents of your stomach from flowing up into your oesophagus – the lower oesophageal sphincter – stops working properly.

Fundoplication involves wrapping the upper portion of the stomach (the fundus) around the oesophagus, either partially or totally.

Fundoplication procedures have been used for many years through laparoscopy or open abdominal incisions.

What is TIF?

TIF is an incisionless approach to fundoplication. An endoscopic device is inserted through the mouth, down the oesophagus and into the upper portion of the stomach.

This device enables medical professionals to reach the stomach valve and stomach without the need for cutting stomach tissue.

More than 22,000 TIF procedures have been performed worldwide.

How is it performed?

TIF can be done using the EsophyX device by EndoGastric Solutions or the Medigus Ultrasonic Surgical Endostapler system (MUSE).

The EsophyX device is an automatic stapler-like fastener delivery system inserted through the patient’s mouth with direct visual guidance from an endoscope. It enables creation of a 3cm, 270° esophagogastric fundoplication.

MUSE uses a surgical endostapler to place metal stitches under an ultrasound guide.

Do results differ?

A research study has concluded that at a six and 12-month follow-up, there are ‘no statistically significant difference in clinical, pathophysiological and endoscopic results between TIF with Esophyx and MUSE systems’.

How successful is the surgery?

TIF has been studied in several randomised controlled trials with favourable outcomes and a low rate of adverse events.

The majority of studies have used the EsophyX device, with limited studies into the MUSE system.

According to EndoGastric Solutions, the TIF procedure has been evaluated in more than 100 published papers from 75 centres. Eighty per cent of US patients reported being off daily proton pump inhibitor (PPI) medication and 82 per cent had healed their esophagitis.

Following MUSE, Medigus reports withdrawal of PPI use in 74-79 per cent of patients and a significantly lower number of total refluxes recorded by 24h-esophageal impedance.

Side effects of TIF

All procedures have risks. Temporary dysphagia (difficulty swallowing) or odynophagia (painful swallowing) has been reported following this treatment.

Further information on more serious adverse affects can be found on the EndoGastric website.

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