Publication Date
7-1-2024
Journal
Saudi Journal of Gastroenterology
DOI
10.4103/sjg.sjg_22_24
PMID
38465439
PMCID
PMC11379255
PubMedCentral® Posted Date
3-11-2024
PubMedCentral® Full Text Version
Post-Print
Published Open-Access
yes
Keywords
Humans, Gastroesophageal Reflux, Fundoplication, Female, Prospective Studies, Male, Pilot Projects, Middle Aged, Adult, Quality of Life, Treatment Outcome, Proton Pump Inhibitors, Myotomy, Natural Orifice Endoscopic Surgery, Postoperative Complications, Aged, GERD, laparoscopic Heller myotomy, peroral endoscopic myotomy, POEM, reflux, TIF, transoral incisionless fundoplication
Abstract
BACKGROUND: Gastroesophageal reflux (GERD) is a concern after peroral endoscopic myotomy (POEM). Transoral incisionless fundoplication (TIF) has been recently described as a possible therapy for post-POEM GERD in case series.
METHODS: We prospectively enrolled patients undergoing POEM who agreed to participate in objective post-procedure GERD evaluation. Patients with objective evidence of GERD and suitable anatomy were offered TIF vs. proton pump inhibitor (PPI) only. Patients who underwent TIF were compared to those on PPI-only therapy after follow-up.
RESULTS: Of 21 enrolled POEM patients with objective testing, GERD was found in 11 (52%). Of those eligible for TIF, 4 (40%) opted to pursue TIF and were compared to those on PPI-only therapy ( n = 6). Three months post-TIF, 75% of patients had discontinued or significantly decreased PPI. There were no adverse events. GERD health-related quality of life scores were low and comparable between TIF (3.75 ± 6.2) and those who remained on PPI-only therapy (4.1 ± 5).
CONCLUSION: In this pilot, patient-driven prospective study, 75% of patients with post-POEM GERD undergoing TIF had stopped or significantly reduced PPI use. Post-POEM TIF is safe and effective and may be a viable alternative to PPI for POEM-related GERD; however, future studies should include a control arm and post-intervention pH monitoring.