Scholarlink

Introduction <p>Transoral incisionless fundoplication (TIF) is FDA-approved for patients with hiatal hernia &lt; 2&#xa0;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.</p> Method <p>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.</p> Results <p>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&#xa0;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 (<i>p</i> = 0.024). GERD Health-related Quality of Life (GERD-HRQL) scores improved from 29.5 to 14.0 (<i>p</i> = 0.097). Thirteen of 20 patients improved to HG I–II. One patient (3.7%) required surgical revision.</p> Conclusions <p>Our findings support AFS recommendations for preoperative HG assessment. TIF may remain a viable adjunct to PPI therapy in select non-surgical candidates with hernia &lt; 2&#xa0;cm.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

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

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年1月20日

查看全文
  • Yinglin Gao,
  • Fouad Jaber,
  • Muaaz Masood,
  • Ashwin Rao,
  • Rajesh Krishnamoorthi,
  • Charlie Borzy,
  • John G. Hunter,
  • J.M. Conchillo,
  • Nicole B Bouvy,
  • Bengt Håkanson,
  • Lars Lundell,
  • Ruben Hernaez,
  • Wasseem Skef

摘要

Introduction

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.

Method

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.

Results

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.

Conclusions

Our findings support AFS recommendations for preoperative HG assessment. TIF may remain a viable adjunct to PPI therapy in select non-surgical candidates with hernia < 2 cm.