1
|
Calabrese F, Poletti V, Auriemma F, Paduano D, Gentile C, Facciorusso A, Franchellucci G, De Marco A, Brandaleone L, Ofosu A, Samanta J, Ramai D, De Luca L, Al-Lehibi A, Zuliani W, Hassan C, Repici A, Mangiavillano B. New Perspectives in Endoscopic Treatment of Gastroesophageal Reflux Disease. Diagnostics (Basel) 2023; 13:2057. [PMID: 37370952 DOI: 10.3390/diagnostics13122057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/05/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
Gastroesophageal reflux disease has a high incidence and prevalence in the general population. Clinical manifestations are heterogenous, and so is the response to medical treatment. Proton pump inhibitors are still the most common agents used to control reflux symptoms and for healing esophagitis, but they are not a one-size-fits-all solution for the disease. Patients with persistent troublesome symptoms despite medical therapy, those experiencing some adverse drug reaction, or those unwilling to take lifelong medications deserve valid alternatives. Anti-reflux Nissen fundoplication is an effective option, but the risk of adverse events has limited its spread. In recent years, advancements in therapeutic endoscopy have been made, and three major endoluminal alternatives are now available, including (1) the delivery of radiofrequency energy to the esophago-gastric junction, (2) transoral incisionless fundoplication (TIF), and (3) anti-reflux mucosal interventions (ARMI) based on mucosal resection (ARMS) and mucosal ablation (ARMA) techniques to remodel the cardia. Endoscopic techniques have shown interesting results, but their diffusion is still limited to expert endoscopists in tertiary centers. This review discusses the state of the art in the endoscopic approach to gastroesophageal reflux disease.
Collapse
Affiliation(s)
- Federica Calabrese
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, 21053 Castellanza, Italy
| | - Valeria Poletti
- Endoscopy Unit, Humanitas Clinical and Research Center-IRCCS, 20089 Rozzano, Italy
| | - Francesco Auriemma
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, 21053 Castellanza, Italy
| | - Danilo Paduano
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, 21053 Castellanza, Italy
| | - Carmine Gentile
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, 21053 Castellanza, Italy
| | - Antonio Facciorusso
- Section of Gastroenterology, Department of Medical Sciences, University of Foggia, 71100 Foggia, Italy
| | | | - Alessandro De Marco
- Endoscopy Unit, Humanitas Clinical and Research Center-IRCCS, 20089 Rozzano, Italy
| | - Luca Brandaleone
- Endoscopy Unit, Humanitas Clinical and Research Center-IRCCS, 20089 Rozzano, Italy
| | - Andrew Ofosu
- Division of Digestive Diseases, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Jayanta Samanta
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Daryl Ramai
- Division of Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT 84132, USA
| | - Luca De Luca
- Endoscopic Unit, ASST Santi Paolo e Carlo, 20142 Milan, Italy
| | - Abed Al-Lehibi
- King Fahad Medical City, Faculty of Medicine, King Saud Bin Abduaziz University-Health Science, Riyadh 11525, Saudi Arabia
| | - Walter Zuliani
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, 21053 Castellanza, Italy
| | - Cesare Hassan
- Endoscopy Unit, Humanitas Clinical and Research Center-IRCCS, 20089 Rozzano, Italy
| | - Alessandro Repici
- Endoscopy Unit, Humanitas Clinical and Research Center-IRCCS, 20089 Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | | |
Collapse
|
2
|
Trad KS, Barnes WE, Prevou ER, Simoni G, Steffen JA, Shughoury AB, Raza M, Heise JA, Fox MA, Mavrelis PG. The TEMPO Trial at 5 Years: Transoral Fundoplication (TIF 2.0) Is Safe, Durable, and Cost-effective. Surg Innov 2018; 25:149-157. [PMID: 29405886 PMCID: PMC5946656 DOI: 10.1177/1553350618755214] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Questions remain about the therapeutic durability of transoral incisionless fundoplication (TIF). In this study, clinical outcomes were evaluated at 5 years post-TIF 2.0. METHODS A total of 63 chronic gastroesophageal reflux disease (GERD) sufferers with troublesome symptoms refractory to proton pump inhibitor (PPI) therapy, absent or ≤2 cm hiatal hernia, and abnormal esophageal acid exposure were randomized to the TIF group or PPI group. Following the 6-month evaluation, all patients in the PPI group elected for crossover to TIF; therefore, all 63 patients underwent TIF 2.0 with EsophyX2 device. Primary outcome was elimination of daily troublesome regurgitation and atypical symptoms at the 5-year follow-up. Secondary outcomes were improvement in symptom scores, PPI use, reoperations, and patient health satisfaction. The cost-effectiveness of TIF 2.0 was also estimated. RESULTS Of 63 patients, 60 were available at 1 year, 52 at 3 years, and 44 at 5 years for evaluation. Troublesome regurgitation was eliminated in 88% of patients at 1 year, 90% at 3 years, and 86% at 5 years. Resolution of troublesome atypical symptoms was achieved in 82% of patients at 1 year, 88% at 3 years, and 80% at 5 years. No serious adverse events occurred. There were 3 reoperations by the end of the 5-year follow-up. At the 5-year follow-up, 34% of patients were on daily PPI therapy as compared with 100% of patients at screening. The total GERD Health-related quality-of-life score improved by decreasing from 22.2 to 6.8 at 5 years ( P < .001). CONCLUSION In this patient population, the TIF 2.0 procedure provided safe and sustained long-term elimination of troublesome GERD symptoms.
Collapse
Affiliation(s)
- Karim S Trad
- 1 The George Washington University School of Medicine and Health Science, Washington, DC, USA.,2 The George Washington University Medical Faculty Associates, Washington, DC, USA
| | - William E Barnes
- 3 Livingston Hospital and Healthcare Services, Inc, CAH, Salem, KY, USA
| | - Elizabeth R Prevou
- 2 The George Washington University Medical Faculty Associates, Washington, DC, USA
| | - Gilbert Simoni
- 4 Advanced Gastroenterology, Inc, Thousand Oaks, CA, USA
| | - Jennifer A Steffen
- 2 The George Washington University Medical Faculty Associates, Washington, DC, USA
| | - Ahmad B Shughoury
- 5 Saint Mary Medical Center, Hobart, IN, USA.,6 Internal Medicine Associates, Merrillville, IN, USA
| | - Mamoon Raza
- 7 Indiana Medical Research, Elkhart, IN, USA.,8 Unity Surgical Hospital, Mishawaka, IN, USA
| | | | - Mark A Fox
- 10 Crossville Medical Group, Crossville, TN, USA.,11 Cumberland Medical Center, Crossville, TN, USA
| | - Peter G Mavrelis
- 5 Saint Mary Medical Center, Hobart, IN, USA.,6 Internal Medicine Associates, Merrillville, IN, USA
| |
Collapse
|
3
|
Trad KS, Barnes WE, Simoni G, Shughoury AB, Mavrelis PG, Raza M, Heise JA, Turgeon DG, Fox MA. Transoral incisionless fundoplication effective in eliminating GERD symptoms in partial responders to proton pump inhibitor therapy at 6 months: the TEMPO Randomized Clinical Trial. Surg Innov 2014; 22:26-40. [PMID: 24756976 PMCID: PMC4361451 DOI: 10.1177/1553350614526788] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Incomplete control of troublesome regurgitation and extraesophageal manifestations of chronic gastroesophageal reflux disease (GERD) is a known limitation of proton pump inhibitor (PPI) therapy. This multicenter randomized study compared the efficacy of transoral incisionless fundoplication (TIF) against PPIs in controlling these symptoms in patients with small hiatal hernias. METHODS Between June and August 2012, 63 patients were randomized at 7 US community hospitals. Patients in the PPI group were placed on maximum standard dose (MSD). Patients in the TIF group underwent esophagogastric fundoplication using the EsophyX2 device. Primary outcome was elimination of daily troublesome regurgitation or extraesophageal symptoms. Secondary outcomes were normalization of esophageal acid exposure (EAE), PPI usage and healing of esophagitis. RESULTS Of 63 randomized patients (40 TIF and 23 PPI), 3 were lost to follow-up leaving 39 TIF and 21 PPI patients for analysis. At 6-month follow-up, troublesome regurgitation was eliminated in 97% of TIF patients versus 50% of PPI patients, relative risk (RR) = 1.9, 95% confidence interval (CI) = 1.2-3.11 (P = .006). Globally, 62% of TIF patients experienced elimination of regurgitation and extraesophageal symptoms versus 5% of PPI patients, RR = 12.9, 95% CI = 1.9-88.9 (P = .009). EAE was normalized in 54% of TIF patients (off PPIs) versus 52% of PPI patients (on MSD), RR = 1.0, 95% CI = 0.6-1.7 (P = .914). Ninety percent of TIF patients were off PPIs. CONCLUSION At 6-month follow-up, TIF was more effective than MSD PPI therapy in eliminating troublesome regurgitation and extraesophageal symptoms of GERD.
Collapse
Affiliation(s)
- Karim S Trad
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA Reston Surgical Associates, Reston, VA, USA
| | - William E Barnes
- Livingston Hospital and Healthcare Services, Inc, CAH, Salem, KY, USA
| | | | - Ahmad B Shughoury
- Saint Mary Medical Center, Hobart, IN, USA Internal Medicine Associates, Merrillville, IN, USA
| | - Peter G Mavrelis
- Saint Mary Medical Center, Hobart, IN, USA Internal Medicine Associates, Merrillville, IN, USA
| | - Mamoon Raza
- Indiana Medical Research, Elkhart, IN, USA Unity Surgical Hospital, Mishawaka, IN, USA
| | | | - Daniel G Turgeon
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA Reston Surgical Associates, Reston, VA, USA
| | - Mark A Fox
- Crossville Medical Group, Crossville, TN, USA Cumberland Medical Center, Crossville, TN, USA
| |
Collapse
|