Transoral Incisionless Fundoplication for patients with Gastroesophageal Reflux Disease after Peroral Endoscopic Myotomy: a prospective cohort
ABSTRACT BACKGROUND AND STUDY AIMS Achalasia is a condition related to the failure of relaxation of the lower esophageal sphincter (LES). Treatment is based on reducing LES pressure. While treatment is traditionally surgical, poor candidates for this modality may be treated with peroral endoscopic...
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Georg Thieme Verlag KG
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| Series: | Endoscopy International Open |
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| author | 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 |
| author_facet | 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 |
| author_sort | Eduardo Guimarães Hourneaux de Moura |
| collection | DOAJ |
| description | ABSTRACT
BACKGROUND AND STUDY AIMS Achalasia is a condition related to the failure of relaxation of the lower esophageal sphincter (LES). Treatment is based on reducing LES pressure. While 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 ten 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 ten cases treated with TIF. In the 6-month and 12-month follow-up, 7 (70%) patients reduced PPI use. Two patients (20%) had no esophagitis initially, increasing to five (55%) at 6 months and four (44%) at 12 months. The symptoms evaluation and GERD-HRQL questionnaire showed a significant score reduction at 6 months and a downward trend at 12 months. The mean Eckardt score showed a decreasing trend although mean dysphagia score showed a slight tendency to increase in one year. The procedure was considered safe, with no adverse event. CONCLUSIONS The use of TIF seems to be a feasible alternative in treating GERD after POEM, improving both clinical and endoscopic parameters and pHmetry in a considerable percentage of cases. |
| format | Article |
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| institution | Kabale University |
| issn | 2364-3722 2196-9736 |
| language | English |
| publisher | Georg Thieme Verlag KG |
| record_format | Article |
| series | Endoscopy International Open |
| spelling | doaj-art-a5f8ca6892fd49fd89528079167d000e2025-08-20T03:40:44ZengGeorg Thieme Verlag KGEndoscopy International Open2364-37222196-973610.1055/a-2681-2538Transoral Incisionless Fundoplication for patients with Gastroesophageal Reflux Disease after Peroral Endoscopic Myotomy: a prospective cohortEduardo Guimarães Hourneaux de Moura0https://orcid.org/0000-0002-8023-3722Matheus Ferreira de Carvalho1https://orcid.org/0000-0002-9230-0953Victor Lira de Oliveira2https://orcid.org/0000-0002-5132-0309Mateus Bond Boghossian3https://orcid.org/0000-0002-2641-4952Antonio Afonso Miranda Neto4Eduardo Turiani Hourneaux de Moura5André Orsini Ardengh6Ary Nasi7Kenneth Chang8Mateus Pereira Funari9https://orcid.org/0000-0002-4828-9320Gastrointestinal Endoscopy Department, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, BrazilGastrointestinal Endoscopy Unit, Gastroenterology Department, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao PauloGastrointestinal Endoscopy Unit, Gastroenterology Department, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, BrazilGastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, BrazilDepartment of Gastroenterology, Hospital das Clinicas from University of Sao Paulo School of Medicine, Sao Paulo, BrazilGastrointestinal Endoscopy Unit, Gastroenterology Department, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, BrazilSurgery, Faculdade de Ciências Médicas da Santa Casa de São Paulo, Sao Paulo, BrazilGastrointestinal Endoscopy Unit, Gastroenterology Department, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, BrazilMedicine, University of California Irvine, Irvine, United StatesEndoscopy FMUSP, Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas, Sao Paulo, BrazilABSTRACT BACKGROUND AND STUDY AIMS Achalasia is a condition related to the failure of relaxation of the lower esophageal sphincter (LES). Treatment is based on reducing LES pressure. While 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 ten 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 ten cases treated with TIF. In the 6-month and 12-month follow-up, 7 (70%) patients reduced PPI use. Two patients (20%) had no esophagitis initially, increasing to five (55%) at 6 months and four (44%) at 12 months. The symptoms evaluation and GERD-HRQL questionnaire showed a significant score reduction at 6 months and a downward trend at 12 months. The mean Eckardt score showed a decreasing trend although mean dysphagia score showed a slight tendency to increase in one year. The procedure was considered safe, with no adverse event. CONCLUSIONS The use of TIF seems to be a feasible alternative in treating GERD after POEM, improving both clinical and endoscopic parameters and pHmetry in a considerable percentage of cases.http://www.thieme-connect.de/DOI/DOI?10.1055/a-2681-2538 |
| spellingShingle | 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: a prospective cohort Endoscopy International Open |
| title | Transoral Incisionless Fundoplication for patients with Gastroesophageal Reflux Disease after Peroral Endoscopic Myotomy: a prospective cohort |
| title_full | Transoral Incisionless Fundoplication for patients with Gastroesophageal Reflux Disease after Peroral Endoscopic Myotomy: a prospective cohort |
| title_fullStr | Transoral Incisionless Fundoplication for patients with Gastroesophageal Reflux Disease after Peroral Endoscopic Myotomy: a prospective cohort |
| title_full_unstemmed | Transoral Incisionless Fundoplication for patients with Gastroesophageal Reflux Disease after Peroral Endoscopic Myotomy: a prospective cohort |
| title_short | Transoral Incisionless Fundoplication for patients with Gastroesophageal Reflux Disease after Peroral Endoscopic Myotomy: a prospective cohort |
| title_sort | transoral incisionless fundoplication for patients with gastroesophageal reflux disease after peroral endoscopic myotomy a prospective cohort |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/a-2681-2538 |
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