Incisionless Procedure Offers Less Invasive Treatment for Reflux

A device the size of a toy fishing pole makes it possible to perform less invasive surgery on reflux patients. The procedure—transoral incisionless fundoplication (TIF)—may be an alternative to a more common laparoscopic operation for some sufferers of gastroesophageal reflux disease (GERD).

While the TIF repair is typically undertaken by general surgeons, otolaryngologists are often involved in the care of patients whose reflux problems extend beyond the esophagus and into the upper airway, causing atypical GERD symptoms such as chronic cough, hoarseness, laryngeal nodules, swallowing difficulties, throat pain and persistent sinus infections.

“I’ve been referring patients for the [TIF] procedure for about four years. It’s a great option for those with laryngopharyngeal reflux [LGR],” said Ed Hepworth, MD, an otolaryngologist and director of the Colorado Sinus Institute in Denver. These patients don’t present with the typical esophageal manifestations of GERD, but they may instead experience frequent infections, nasal polyps and sinonasal problems without other explanation. TIF also works well to combat persistent hoarseness and frequent throat clearing in properly selected patients. Several of Dr. Hepworth’s patients who underwent TIF have been relieved of their chronic cough, and some patients have been able to avoid antibiotics and sinus surgery.

Advantages over the Traditional Surgery

During TIF, patients are spared the small but multiple abdominal incisions, as well as the occasional side effects, needed for a laparoscopic Nissen fundoplication, the conventional “gold standard” operation for heartburn control. The EsophyX device, manufactured by EndoGastric Solutions of Redmond, Wash., is maneuvered transorally to the gastroesophageal junction, and a device is inserted that prevents gastroesophageal reflux.

“This procedure really is revolutionary in that it gives us an option to repair small hiatal hernias and refractory GERD. We have found it to be particularly useful for patients with laryngopharyngeal reflux.”

—Karim Trad, MD

“This procedure really is revolutionary in that it gives us an option to repair small hiatal hernias and refractory GERD,” said Karim Trad, MD, an assistant professor in the department of surgery at George Washington University in Washington, D.C., and a general surgeon specializing in minimally invasive techniques. “We have found it to be particularly useful for patients with laryngopharyngeal reflux [LPR]. The traditional medical treatment of using proton-pump inhibitors has been found less than optimal and not very successful. Patients with LPR typically are placed on double-dose proton-pump inhibitors and oftentimes go for many years before the correct diagnosis is made.”

Side effects of the TIF procedure may include a few weeks of bloating, belching or other vague abdominal complaints, and there can be aggravation of esophageal dysmotility. However, these problems generally resolve on their own, said Dr. Hepworth.