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Efficacy of transoral incisionless fundoplication (TIF) for the treatment of GERD: a systematic review with meta-analysis

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Abstract

Background

The efficacy of transoral incisionless fundoplication (TIF) performed with the EsophyX device (Redmond, Washington, USA) and its long-term outcomes in gastresophageal reflux disease (GERD) are debated. We, therefore, performed a systematic review with meta-analysis of studies evaluating the role of TIF in GERD.

Methods

A systematic search of EMBASE, SCOPUS, PubMed, and the Cochrane Library Central was performed. All original studies reporting outcomes in GERD patients who underwent TIF were identified. Only randomized controlled trials (RCTs) evaluating the efficacy of TIF, and prospective observational studies reporting outcomes after TIF were included.

Results

A total of 18 studies (963 patients) published between 2007 and 2015 were identified, including five RCTs and 13 prospective observational studies. The pooled relative risk of response rate to TIF versus PPIs/sham was 2.44 (95 % CI 1.25–4.79, p = 0.0009) in RCTs in the intention-to-treat analysis. The total number of refluxes was reduced after TIF compared with the PPIs/sham group. The esophageal acid exposure time and acid reflux episodes after TIF were not significantly improved. Proton-pump inhibitors (PPIs) usage increased with time and most of the patients resumed PPIs treatment at reduced dosage during the long-term follow-up. The total satisfaction rate after TIF was about 69.15 % in 6 months. The incidence of severe adverse events consisting of gastrointestinal perforation and bleeding was 2.4 %.

Conclusions

TIF is an alternative intervention in controlling GERD-related symptoms with comparable short-term patient satisfaction. Long-term results showed decreased efficacy with time. Patients often resume PPIs at reduced doses in the near future.

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Acknowledgments

Guarantor of the article: HUANG Xiaoquan. The authors are grateful to Center of Evidence-Based Medicine, Fudan University, 200032, Shanghai, China.

Author contributions

HUANG Xiaoquan contributed to study conception and design; article retrieval; data extraction; analysis and interpretation of data; risk of bias rating; statistical analyses; manuscript writing. CHEN Shiyao helped with study conception and design; data extraction; analysis and interpretation of data; statistical analyses. ZHAO Hetong is acknowledged for article retrieval; data extraction; analysis and interpretation of data; risk of bias rating. ZENG Xiaoqing drafted the manuscript and provided supervision. LIAN Jingjing contributed to analysis and interpretation of data; risk of bias rating; TSENG YuJen: manuscript writing and modification. CHEN Jie critically revised the manuscript for important intellectual content. All authors approved the final version of the manuscript, including the authorship list.

Funding

This work was supported by the Foundation of Discipline Construction of Evidence-based Medicine Center, Zhongshan Hospital, China. And the study was partly supported by the Fund of National Science & Technology Pillar Program (No. 2013BAI09B14). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Center of Evidence-Based Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China

    Xiaoquan Huang, Shiyao Chen & Jingjing Lian

  2. Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, 200032, China

    Xiaoquan Huang, Shiyao Chen & Jingjing Lian

  3. Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China

    Shiyao Chen, Xiaoqing Zeng, Yujen Tseng & Jie Chen

  4. Department of Traditional Chinese Medicine, Changhai Hospital, Shanghai, 200433, China

    Hetong Zhao

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  1. Xiaoquan Huang
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Correspondence to Shiyao Chen.

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CHEN Shiyao received grants from National Science and Technology Pillar Program. The funder had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. HUANG Xiaoquan, CHEN Shiyao, ZHAO Hetong, ZENG Xiaoqing, LIAN Jingjing, TSENG Yujen, CHEN Jie have no conflicts of interest or financial ties to disclose.

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Huang, X., Chen, S., Zhao, H. et al. Efficacy of transoral incisionless fundoplication (TIF) for the treatment of GERD: a systematic review with meta-analysis. Surg Endosc 31, 1032–1044 (2017). https://doi.org/10.1007/s00464-016-5111-7

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