Ebright Michael I, Sridhar Praveen, Litle Virginia R, Narsule Chaitan K, Daly Benedict D, Fernando Hiran C
From the *Section of Thoracic Surgery, Columbia University Medical Center, New York, NY USA; †Division of Thoracic Surgery, Boston University School of Medicine, Boston Medical Center, Boston, MA USA; and ‡Section of Thoracic Surgery, Inova Fairfax Hospital, Fairfax, VA USA.
Innovations (Phila). 2017 May/Jun;12(3):180-185. doi: 10.1097/IMI.0000000000000351.
Transoral incisionless fundoplication (TIF) is a completely endoscopic approach to treat gastroesophageal reflux disease (GERD). We previously reported our initial results demonstrating safety and early effectiveness. We now present an updated experience describing outcomes with longer follow-up.
For a three-year period, TIF procedures were performed on 80 patients. Preoperative workup routinely consisted of contrast esophagram and manometry. PH testing was reserved for patients with either atypical symptoms or typical symptoms unresponsive to proton-pump inhibitors (PPIs). Heartburn severity was longitudinally assessed using the GERD health-related quality of life index. Safety analysis was performed on all 80 patients, and an effectiveness analysis was performed on patients with at least 6-month follow-up.
Mean procedure time was 75 minutes. There were seven (8.75%) grade 2 complications and one (1.25%) grade 3 complication (aspiration pneumonia). The median length of stay was 1 day (mean, 1.4). Forty-one patients had a minimum of 6-month of follow-up (mean, 24 months; range, 6-68 months). The mean satisfaction scores at follow-up improved significantly from baseline (P < 0.001). Sixty-three percent of patients had completely stopped or reduced their PPI dose. Results were not impacted by impaired motility; however, the presence of a small hiatal hernia or a Hill grade 2/4 valve was associated with reduced GERD health-related quality of life scores postoperatively.
At a mean follow-up of 24 months, TIF is effective. Although symptoms and satisfaction improved significantly, many patients continued to take PPIs. Future studies should focus on longer-term durability and comparisons with laparoscopic techniques.
经口无切口胃底折叠术（TIF）是一种治疗胃食管反流病（GERD）的完全内镜手术方法。我们之前报告了初步结果，证明了其安全性和早期有效性。我们现在展示更新后的经验，描述更长随访期的结果。
在三年时间里，对80例患者实施了TIF手术。术前常规检查包括食管造影和测压。pH检测适用于有非典型症状或对质子泵抑制剂（PPI）无反应的典型症状患者。使用GERD健康相关生活质量指数纵向评估烧心严重程度。对所有80例患者进行安全性分析，对至少随访6个月的患者进行有效性分析。
平均手术时间为75分钟。有7例（8.75%）2级并发症和1例（1.25%）3级并发症（吸入性肺炎）。中位住院时间为1天（平均1.4天）。41例患者至少随访了6个月（平均24个月；范围6 - 68个月）。随访时的平均满意度评分较基线有显著改善（P < 0.001）。63%的患者完全停用或减少了PPI剂量。结果不受动力障碍影响；然而，存在小的食管裂孔疝或希尔2/4级瓣膜与术后GERD健康相关生活质量评分降低有关。
平均随访24个月时，TIF是有效的。尽管症状和满意度有显著改善，但许多患者仍继续服用PPI。未来的研究应侧重于长期疗效以及与腹腔镜技术的比较。
