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Transoral Incisionless Fundoplication (TIF)
Transoral incisionless fundoplication (TIF) is an advanced endoscopy procedure that provides relief from acid reflux (heartburn) symptoms associated with chronic gastroesophageal reflux disease (GERD). Our skilled gastroenterologists offer TIF as a way to treat GERD without surgery. The result may be a shorter treatment time, less pain and faster recovery than with laparoscopic surgery.
Gastroenterologists are physicians trained to treat the gastrointestinal (GI) tract. They use a flexible, tube-like imaging instrument called an endoscope to look inside your body.
For TIF, the doctor feeds the endoscope through a special TIF device. The device allows the physician to repair or recreate the body's natural barrier to reflux. It uses preloaded forceps (tweezers) and fasteners and requires no incision.
Transoral Incisionless Fundoplication: Why It’s Performed
Our gastroenterologists use the TIF device for patients who have heartburn or regurgitation after eating. Those symptoms occur because a malfunctioning valve allows stomach acid back into the esophagus.
Patients whose GERD symptoms respond to proton pump inhibitors (PPI) or other antiacid medications but who wish to avoid these options are also candidates for TIF. In some cases, medications are no longer effective or do not provide complete relief. For these patients, valve repair may be the only option.
TIF Procedure for GERD | Frank's Story
Persistent and painful belching that caused a disruptive lifestyle and interrupted sleep led Frank to Mimi Canto, M.D., at Johns Hopkins to perform the Transoral Incisionless Fundoplication (TIF) procedure to treat his chronic gastroesophageal reflux disease (GERD). Frank is now symptom free, able to eat a normal diet and sleep without interruption.
TIF As an Alternative to Nissen Fundoplication
Doctors can use TIF instead of a laparoscopic surgical procedure called Nissen fundoplication. With Nissen fundoplication, doctors make an incision and then wrap the top of the stomach around the esophagus to recreate a valve.
Doctors can use TIF instead of Nissen fundoplication to avoid unwanted side effects that Nissen fundoplication may produce, including:
- Trouble swallowing
- Difficulty eating for several months
- Trapped air resulting in belching or bloating
- Hernia at the incision location
Unfortunately, a valve created using Nissen fundoplication may fail within eight to 10 years. At that point, patients may need a repeat procedure. Doctors can use TIF to repair a valve previously created with Nissen fundoplication.
TIF: How to Prepare
Before your TIF:
- You will undergo pH monitoring using wireless pH testing (called the Bravo test). We use this test to document the severity of the condition and to ensure you are a good candidate for the procedure.
- You may also need to have a special video X-ray test to examine your anatomy. This test lets your doctor look at the functioning of your esophagus and valve. Your doctor can also assess the size of a hiatal hernia, if present.
- Do not eat or drink for 12 hours before the procedure to clear your esophagus of food products.
- Tell your doctor if you have any allergies.
- Follow your doctor’s instructions about whether to take your prescription medications.
TIF: What to Expect
On the day of your procedure, arrive at the endoscopy unit one hour before the procedure. You will register and provide your medical history, including any medications you have taken.
During the procedure, your gastroenterologist and the TIF team will:
- Deliver anesthesia to make you sleepy.
- Pass a high-definition endoscope into your mouth through the TIF device. Your doctor will observe the images on a screen.
- Insert the TIF device with endoscope into the stomach. The endoscope is turned to point toward the top of the stomach. This angle enables the doctor to see the opening of the esophagus and stomach.
- Use the TIF device to grab the end of your esophagus, bring it down and wrap the top of the stomach about 270 degrees around it.
- Secure the new valve with durable plastic fasteners that remain in the body.
- Remove the TIF device and endoscope through the newly created valve and out of the mouth.
After the procedure, you might have a brief stay in the hospital (typically less than 24 hours) or you may be discharged home if you feel well, which makes this procedure an outpatient treatment. You will receive antibiotics for 2–3 days and medications for symptom relief if you need them.
Your gastroenterologist will discuss your procedure and results with you before you are discharged. After the procedure, you can eat clear liquids only for the first 24 hours. Following that, you will have one week of full liquids, then one week of soft foods. You can resume your regular diet on the third week, avoiding breads and meats for a month. In terms of physical activity, you can return to modified activity within three weeks and full activity after five weeks.
Common, short-term side effects of TIF may include:
- Sore throat
- Shoulder pain
- Minimal chest pain
- Minimal chance of bleeding