Alternative treatment for patients who suffer chronic heartburn and esophageal reflux disease that either don’t respond well enough to Proton Pump Inhibitor therapy, cannot tolerate PPI therapy, or just don’t want to be taking those medications long term. It is also an excellent option for patients with NON-ACID or BILE REFLUX as it restores the high pressure zone of the LES and crus. It is an endoscopic procedure to perform a small hernia reduction and do a fundoplication to tighten the natural sphincter area of the lower esophagus and prevent reflux. It is an alternative to the general surgical approach that has more complications such as gas bloat symptom, dysphagia, diarrhea, as well as the surgical complications of herniation of the fundoplication, slipped fundoplication, tight fundoplication, paraesophageal hernia and malposition of the fundoplicaton. Re-operation rates for surgical treatment range up to 15%.
To qualify you need to have proven reflux either by biopsy changes or by a positive pH test like a Bravo , LA Class C or less esophagitis, and either no hiatal hernia, or one that is only 2cm or smaller
No aspirin or blood thinners for a week prior to procedure. No smoking or alcohol for 24 hrs prior to procedure.
Requires a trans-nasal intubation for general anesthesia and an overnight hospital stay for observation. There may be some chest discomfort for a few days as well as irritation of the nose and throat that are manageable and also go away quickly.
The data for outcomes on the TIF2 procedure are comparable to standard Nissen Fundoplication without the severe complications. IF it is not effective it doesn’t preclude doing a standard Nissen procedure.
Risks include all the expected risks of general anesthesia. Post operative pain is generally self limited. There is a small risk of post procedure bleeding or infection. There is the standard procedural risk of perforation of the esophagus.
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