Efficacy and safety of transoral incisionless fundoplication in non-obese and obese adults: a population-based cohort study from the United States
Abstract
Transoral incisionless fundoplication (TIF) is relatively contraindicated in patients with a body mass index (BMI) > 35 kg/m2. However, the comparative efficacy of TIF in individuals with class I obesity (BMI 30–34.9) to non-obese patients remains unclear. This study aimed to evaluate the safety and efficacy of TIF in adults with class I obesity. We conducted a retrospective cohort study using the TriNetX US Research Network, including data from 69 healthcare organizations through December 2024. Adults (≥ 18 years) with gastroesophageal reflux disease (GERD) who underwent TIF were identified using validated International Classification of Diseases, 10th Revision (ICD-10) and Current Procedural Terminology (CPT) codes. Patients were stratified by BMI ( 35, major esophageal motility disorders, or concomitant hiatal hernia repair. We performed propensity score matching (1:1) and controlled for age, sex, race, ethnicity, diaphragmatic hernia, and proton pump inhibitor (PPI) use. Primary outcomes included postoperative PPI recidivism (excluding the first 3 months), post-TIF esophagitis, and need for subsequent foregut surgery. Secondary outcomes included post-TIF dysphagia, gas bloat symptoms, and 30-day complications. After propensity matching, 112 non-obese and 112 class I obese patients were included with similar baseline characteristics. Median follow-up exceeded 1,000 days in both groups. Postoperative PPI recidivism, esophagitis, surgical interventions, dysphagia and…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
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.