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CC BY 4.0 · Endosc Int Open 2025; 13: a26812538
DOI: 10.1055/a-2681-2538
Original article

Transoral incisionless fundoplication for patients with gastroesophageal reflux disease after peroral endoscopic myotomy: Prospective cohort

Eduardo Guimarães Hourneaux de Moura 
1   Gastrointestinal Endoscopy Unit, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
,
Matheus Ferreira de Carvalho 
1   Gastrointestinal Endoscopy Unit, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
,
Victor Lira de Oliveira 
1   Gastrointestinal Endoscopy Unit, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
,
Mateus Bond Boghossian 
1   Gastrointestinal Endoscopy Unit, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
,
Antonio Afonso Miranda Neto
1   Gastrointestinal Endoscopy Unit, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
,
Eduardo Turiani Hourneaux de Moura
1   Gastrointestinal Endoscopy Unit, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
,
André Orsini Ardengh
2   Surgery, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil (Ringgold ID: RIN37870)
,
Ary Nasi
1   Gastrointestinal Endoscopy Unit, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
,
Kenneth Chang
3   Medicine, University of California Irvine, Irvine, United States (Ringgold ID: RIN8788)
,
Mateus Pereira Funari 
1   Gastrointestinal Endoscopy Unit, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
4   USP, Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil (Ringgold ID: RIN37884)
› Author Affiliations Clinical Trial: Registration number (trial ID): 81178623.0.0000.0068, Trial registry: Brazilian Clinical Trials Registry (http://www.ensaiosclinicos.gov.br/), Type of Study: Prospective
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Abstract

Background and study aims

Achalasia is a condition related to failure of relaxation of the lower esophageal sphincter (LES). Treatment is based on reducing LES pressure. Although treatment is traditionally surgical, poor candidates for this modality may be treated with peroral endoscopic myotomy (POEM). However, POEM is associated with a relatively high incidence of gastroesophageal reflux disease (GERD). For cases refractory to proton pump inhibitors (PPIs), transoral incisionless fundoplication (TIF) is one of the endoscopic therapies proposed.

Patients and methods

This was a pilot single-center prospective cohort study including 10 patients with post-POEM GERD refractory to clinical management who underwent endoscopic treatment with the TIF procedure between February and November 2021. We included patients ≥ 18 years old who developed GERD after POEM.

Results

Technical success was achieved in all 10 cases treated with TIF. In 6- and 12-month follow-up, seven patients (70%) reduced PPI use. Two patients (20%) had no esophagitis initially, increasing to five (55%) at 6 months and four (44%) at 12 months. Symptom evaluation and GERD-HRQL questionnaire showed a significant score reduction at 6 months and a downward trend at 12 months. Mean Eckardt score showed a decreasing trend, although mean dysphagia score showed a slight tendency to increase in 1 year. The procedure was considered safe, with no adverse events.

Conclusions

Use of TIF seems to be a feasible alternative for treating GERD after POEM, improving both clinical and endoscopic parameters and pHmetry in a considerable percentage of cases.

Keywords

Endoscopy Upper GI Tract - Reflux disease - Motility / achalasia - POEM


Publication History

Received: 19 September 2024

Accepted after revision: 24 July 2025

Accepted Manuscript online:
11 August 2025

Article published online:
01 September 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Bibliographical Record
Eduardo Guimarães Hourneaux de Moura, Matheus Ferreira de Carvalho, Victor Lira de Oliveira, Mateus Bond Boghossian, Antonio Afonso Miranda Neto, Eduardo Turiani Hourneaux de Moura, André Orsini Ardengh, Ary Nasi, Kenneth Chang, Mateus Pereira Funari. Transoral incisionless fundoplication for patients with gastroesophageal reflux disease after peroral endoscopic myotomy: Prospective cohort. Endosc Int Open 2025; 13: a26812538.
DOI: 10.1055/a-2681-2538
 

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