Efficacy of Second-generation transoral incisionless fundoplication (TIF 2.0) for treatment of gastroesophageal reflux disease (GERD) in hill grade (HG) III gastroesophageal junction (GEJ): A systematic review and pooled analysis
Abstract
Transoral incisionless fundoplication (TIF) is FDA-approved for patients with hiatal hernia < 2 cm. The American Foregut Society (AFS) recommends TIF only for those with Hill Grade (HG) ≤ 2 and advises cruroplasty for HG ≥ 3, regardless of hernia size. However, many patients may decline or be unfit for surgery. We conducted a systematic review and individual patient data (IPD) pooled analysis to assess the efficacy of TIF 2.0 in patients with severe GERD and HG III anatomy. A systematic search of PubMed and EMBASE through May 2023 identified studies evaluating TIF 2.0. Studies involving cruroplasty (cTIF) or other endoscopic therapies were excluded. Authors of eligible studies were contacted to provide IPD for patients with HG III. The primary outcome was complete cessation of proton pump inhibitors (PPIs). Secondary outcomes included technical success, GERD metrics, HG classification post-TIF, adverse events, and need for reintervention. Twenty-three studies met inclusion criteria and 4 provided IPD for 28 patients with HG III anatomy. Mean age and BMI were 51.1 years and 26.5 kg/m², respectively. Technical success was 100%. At 6 months, PPI cessation rate was 13/27 (46.4%). PPI recidivism occurred in 5/27 patients. Mean esophageal pH improved significantly from 11.9 to 7.5 (p = 0.024). GERD Health-related Quality of Life (GERD-HRQL) scores improved from 29.5 to 14.0 (p = 0.097). Thirteen of 20 patients improved to HG I–II. One patient (3.7%) required surgical revision. Our…
How strong is the evidence?
Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 28 participants or records.
Read the paper
Related studies
- Advantages and Disadvantages of Long-term Proton Pump Inhibitor Use
- Ivth brazilian consensus conference on helicobacter pylori infection
- A pSMAD/CDX2 complex is essential for the intestinalization of epithelial metaplasia
- S2k-Leitlinie Gastroösophageale Refluxkrankheit und eosinophile Ösophagitis der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) – März 2023 – AWMF-Registernummer: 021–013
- Step-by-step management of refractory gastresophageal reflux disease
- Insights into Effects/Risks of Chronic Hypergastrinemia and Lifelong PPI Treatment in Man Based on Studies of Patients with Zollinger–Ellison Syndrome
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.