Abstract
Background Given poor symptomatic response rates and rising awareness of the adverse events
associated with the long-term use of proton pump inhibitors (PPIs), endoscopic modalities
for treatment of refractory gastroesophageal reflux disease (GERD) have become more
prominent. The aim of this study was to perform a systematic review and meta-analysis
to evaluate feasibility, efficacy, and tolerability of transoral incisionless fundoplication
(TIF) for the treatment of refractory GERD.
Methods Searches of PubMed, EMBASE, Web of Science, and Cochrane Library databases were performed
to March 2017. Measured outcomes included immediate technical success rate and serious
adverse events. Symptomatic improvement was measured using GERD Health-related Quality
of Life (HRQL), Gastroesophageal Reflux Symptom Score (GERSS), and Reflux Symptom
Index (RSI). Objective success was determined by hiatal hernia reduction and pH monitoring.
Results 32 studies (1475 patients; 48.2 % male) met inclusion criteria. TIF success rate
was 99 % (95 % confidence interval [CI] 97 to 100; P < 0.001), with an adverse event rate of 2 % (95 %CI 1 to 3; P < 0.001). GERD HRQL, GERSS, and RSI improved significantly post-TIF (mean difference
17.72, 95 %CI 17.31 to 18.14; mean difference 23.78, 95 %CI 22.96 to 24.60; mean difference
14.28, 95 %CI 13.56 to 15.01; all P < 0.001, respectively). Hernia reduction occurred in 91 % of patients (95 %CI 83
to 98; P < 0.001). DeMeester scores improved significantly (mean difference 10.22, 95 %CI
8.38 to 12.12; P < 0.001). PPI therapy was discontinued post-procedure in 89 % of patients (95 %CI
82 to 95; P < 0.001).
Conclusions TIF appears to be a safe and effective endoscopic procedure for patients with refractory
GERD. Future controlled trials are needed to directly compare efficacy, long-term
durability, and safety between TIF and Nissen fundoplication.
