Transoral Incisionless Fundoplication TIF 2.0 with "EsophyX Z®" Device for GERD: Seven Years after Endo Lumenal Fundoplication. World’s First Case Report.

Transoral Incisionless Fundoplication (TIF) with EsophyX device for a well selected GERD patient population has proven its efficacy, safety and durability. We present a case report of a male, 63 y old, with typical and atypical GERD symptoms started 15 years ago. The esophagogastroduodenoscopy (EGD) showed a Hiatal Hernia (HH) of 3 cm and an erosive esophagitis Los Angeles Grade B. The first surgery was performed 7 years ago, in March 2009: a TIF with the EsophyX 2® device (EndoGastric Solution, Inc., Redmond, WA, United States). Post-surgery the symptoms were controlled, completely eliminated, the EGD showing the healing of the esophagitis. Six years after the surgery the sore throat re-appears, while the EGD shows a 2 cm hiatal hernia and erosive esophagitis Los Angeles Grade A. The Impedance pH-metry confirms GERD with a DeMeester score of 44.5. In 2016 (7 years after first procedure) a second and new TIF 2.0 procedure, this time with EsophyX Z device is performed. The EsophyX Z device is an automatic stapler-like fastener delivery system, easier of use, faster, safer and more reproducible (standardized fastener delivery). The time of the procedure was significantly reduced, compared to first procedure. The patient is now symptom free, EGD is normal, the impendance ph metry at 13 months post-surgery showed a normal DeMeester score at 8. This is a World’s first case report of a TIF 2.0 procedure with EsophyX Z device 7 years after a first TIF procedure with EsophyX 2 device, with excellent results and a significant reduction of the time for the procedure.