Transoral Incisionless Surgery (TIF)
Groundbreaking Treatment for Persistent Heartburn
Transoral Incisionless Surgery (TIF) is a revolutionary treatment for gastroesophageal reflux, commonly known as heartburn or acid reflux. Heartburn is a common physiologic event, occurring in most individuals at one time or another. But when it occurs frequently and when an individual develops recurrent symptoms and/or complications, it’s considered gastroesophageal reflux disease (GERD). According to the American Society for Gastrointestinal Endoscopy, up to 30 million people in the U.S. are affected by GERD, with 10 percent of those individuals experiencing symptoms on a daily basis.
“The main cause of chronic reflux is an anatomical abnormality at the junction where the esophagus connects to the stomach,” explains Gary L. Wease, MD, FACS, a general surgeon with Trinity Health. “When a person swallows, the valve between the esophagus and the stomach opens to allow food to pass. Then it closes again to prevent stomach fluids from backing up into the esophagus. For people with chronic acid reflux, this valve has become dysfunctional.”
The most common symptom of GERD is frequent heartburn. Other signs include regurgitation of food or liquid, difficulty swallowing, hoarseness, coughing, and chest pain – especially while lying down at night.
“Most people aren’t aware that there are also long-term complications associated with GERD,” Dr. Wease added. “One that especially affects the elderly is aspiration pneumonia, in which the lungs become inflamed due to gastric contents entering the airway.”
Other complications include difficulty swallowing and increased risk of cancer.
For occasional reflux, lifestyle changes can help such as losing excess weight, eating smaller meals and avoiding foods that seem to trigger the heartburn. Common triggers include caffeine, chocolate, nicotine, alcohol and spicy foods.
But for frequent or chronic heartburn, options range from medications to surgery.
“First line treatments usually involve medications that reduce the production of gastric acid,” Dr. Wease said. “The problem with medical therapy is that it’s designed for short-term use. Long-term use can produced side effects, such as increased risk of bone fractures due to impaired calcium absorption. I meet people in my office who’ve been on medication for 15-20 years because they never realized there was another alternative.”
Surgical options for treating GERD are generally more effective in that they all address the root cause of the reflux – the dysfunctional anti-reflux valve.
“Surgical options have progressed from open surgery to a laparoscopic procedure performed through small incisions,” Dr. Wease explained. “And now we have TIF, which is a game changer in a lot of ways because it makes surgery a significantly more appealing option for a lot of people.”
TIF Surgical Option Incisionless
Transoral Incisionless Fundoplication uses a device called an EsophyX® that lets the surgeon perform a surgical procedure without any incisions. “The TIF procedure is done entirely through the mouth with no incision,” Dr. Wease said. “What we do is to take the upper part of the stomach and wrap it around the esophagus to recreate the anti-reflux valve.”
TIF is performed under general anesthesia and takes about an hour. During the surgery, the EsophyX® device and an endoscope are introduced through the patient’s mouth and advanced into the esophagus. With visualization provided by the endoscope, the surgeon uses the EsophyX® device to reconstruct the anti-reflux valve by wrapping the stomach’s fundus around the distal esophagus and securing it with fasteners. Recovery is typically 3 to 7 days.
Clinical studies show that 80-90 percent of patients remain free of acid reflux symptoms after undergoing the TIF procedure. The incision-free surgery leaves no scars, it reduces recovery time and avoids the negative side effects of long-term medication use.
“The pain is very minimal,” Dr. Wease added. “Many times I’ve done the procedure on a Friday and the patient is back to work on Monday. Patients have to be careful what they eat for about a month after surgery, and we give detailed instructions for that. But after a month or so they can eat what they want. What I generally tell patients is that with TIF we can’t say it will 100% eliminate your chances of having heartburn again. But it can significantly improve your quality of life. Wherever you sit on the scale of discomfort, TIF can enable you to be 85 percent better.”