2010 SSAT QUICK SHOT PRESENTATION Transoral Incisionless Fundoplication 2.0 Procedure Using EsophyX™ for Gastroesophageal Reflux Disease Toshitaka Hoppo & Arul Immanuel & Matthew Schuchert & Zdenek Dubrava & Andrew Smith & Peter Nottle & David I. Watson & Blair A. Jobe Received: 2 July 2010 / Accepted: 11 August 2010 / Published online: 28 September 2010 # 2010 The Society for Surgery of the Alimentary Tract Abstract Background Transoral incisionless fundoplication (TIF) using the EsophyX™ system has been introduced as a possible alternative for the treatment of gastroesophageal reflux disease (GERD). The efficacy of this procedure in our centers was evaluated. Methods Patients were selected for treatment if they had typical GERD symptoms, failed management with proton pump inhibitors (PPIs), a positive esophageal pH test with symptom correlation, and no hiatus hernia larger than 2 cm. Results Nineteen patients (11 men, 8 women) underwent the TIF procedure between April 2008 and July 2009. Mean age was 48.2 years and body mass index was 24.6. The major complication rate was 3/19, including esophageal perforation, hemorrhage requiring transfusion, and permanent numbness of tongue. At mean 10.8 months follow-up, 5/19 had completely discontinued PPIs, and 3/19 had decreased their PPI dose. However, 10/19 had been converted to laparoscopic fundoplication for recurrent reflux symptoms and an endoscopically confirmed failed valve. Nine of 17 were dissatisfied with the outcome, and eight were satisfied. Thirteen of 19 (68%) were considered to have been unsuccessful. Conclusion At short-term follow-up, the TIF procedure is associated with an excessive early symptomatic failure rate, and a high surgical re-intervention rate. This procedure should not be performed outside of a clinical trial. Keywords Transoral incisionless fundoplication . Gastroesophageal reflux disease . EsophyX . Selected population Introduction Gastroesophageal reflux disease (GERD) is the most common esophageal disease in the United States and other Western countries. Population-based studies have demon- strated that 11% of Americans experience daily symptoms of reflux and 33% experience symptoms during a 72-h period. 1 Pharmacologic suppression of gastric acid secre- tion using proton pump inhibitors (PPIs) is the most common approach for long-term management of GERD. 2,3 However, medical therapy requires lifelong commitment and is often not effective in patients with volume reflux. Laparoscopic Nissen fundoplication is the gold standard for the surgical treatment of GERD, and it results in complete symptom relief in more than 90% of patients. 4,5 Despite This paper was presented at the 51st annual meeting of The Society for Surgery of Alimentary Tract, May 4/2010, New Orleans, Louisiana. T. Hoppo : M. Schuchert : B. A. Jobe (*) Division of Thoracic and Foregut Surgery, The Heart, Lung and Esophageal Surgery Institute, Shadyside Medical Center, University of Pittsburgh Medical Center, Suite 715, 5200 Centre Avenue, Pittsburgh, PA 15232, USA e-mail: jobeba@upmc.edu A. Immanuel : D. I. Watson Department of Surgery, Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia Z. Dubrava Alfred Health, Melbourne, VIC, Australia A. Smith : P. Nottle Department of Surgery, Alfred Hospital, Melbourne, VIC, Australia J Gastrointest Surg (2010) 14:1895–1901 DOI 10.1007/s11605-010-1331-7