Medication alone is sometimes not enough to control chronic heartburn (acid reflux) and other symptoms associated with chronic gastroesophageal reflux disease (GERD). If this happens, your doctor may recommend a procedure called transoral incisionless fundoplication (TIF).
This minimally invasive procedure corrects the faulty valve between your stomach and esophagus, the passage connecting your mouth and stomach. It creates a fundoplication, which means a folding of the fundus -- the tissue found at the top of your stomach. When that folded tissue is reinforced by your gastroenterologist, it essentially builds a new barrier that prevents acid from escaping the stomach and moving into the esophagus.
As an endoscopic procedure, it requires no incisions, allowing for a faster and less-painful recovery. During the procedure, your TIF team will insert a special tissue-molding device through your mouth and into your esophagus. Then an endoscope (a thin, flexible tube with a high definition camera on the tip) will be inserted into your esophagus and through the TIF device. This allows your gastroenterologist to guide the TIF device to the place where your stomach and esophagus meet.
Your doctor will then manipulate the TIF device to create a fold by pulling the end of your esophagus about an inch into your stomach. It will be held there by durable plastic fasteners set three-quarters of the way around it.
The TIF device and endoscope are then removed from the new valve and taken out of your mouth. You may be able to go home after the procedure, or you may need to stay overnight at the hospital.
After the procedure, you may need to take antibiotics for two or three days. And for the first 24 hours, you will only be able to drink clear liquids. Over the following three weeks, you will transition from liquids to soft foods and back to your regular diet, though you will need to avoid meat and bread for a month. And you will gradually phase out your GERD medications, as directed by your gastroenterologist.
You will be asked to avoid lifting anything heavier than five pounds and all vigorous physical activity for three weeks. After that, you can resume normal aerobic exercise, while avoiding lifting anything heavier than 50 pounds.
Benefits of the TIF Procedure
Because the TIF procedure repairs the valve between the stomach and esophagus, acid no longer escapes and the long-term use of medicines to control GERD symptoms is not necessary. In addition, recovery is quicker than a surgery because there are no skin incisions, no internal cutting or scarring. Also, the TIF procedure does not limit future treatment options.
Who Is a Candidate for This Procedure?
Medications known as proton pump inhibitors are often considered the treatment of choice for people with early and moderate chronic acid reflux symptoms. But researchers have found that one in four people do not experience adequate relief for a variety of reasons. Among them is an anatomical abnormality that creates a problem with the valve between the stomach and esophagus. Patients with a mild to moderate form of this abnormality and no large hiatal hernia often are good candidates for the TIF procedure.
TIF Procedure FAQs @accordionTitleTag.Name>
For many patients, TIF provides significant GERD symptom relief and improved quality of life. Symptom relief after TIF typically lasts from eight to 10 years.
You will drink only clear liquids for the first 24 hours, then drink full liquids for one week, then eat soft foods for one week and resume your regular diet during the third week. You will have to avoid bread and meat for a month.
You must avoid vigorous physical activity and not lift anything heavier than 5 pounds for three weeks. You can resume aerobic exercise after three weeks but avoid lifting anything heavier than 50 pounds.
Small hiatal hernias can often be repaired during the TIF procedure. Hiatal hernias larger than 2 centimeters cannot be treated with an endoscopic TIF procedure alone and may need to be repaired before TIF, during a laparoscopic surgical procedure called cTIF (TIF with a concomitant hiatal hernia repair).
TIF is a less invasive procedure than Nissen fundoplication, the surgery traditionally performed to repair the valve. During Nissen fundoplication, doctors make an incision in the abdomen and then wrap the top of the stomach all the way around the esophagus to re-create a valve. This wrap acts like a tight belt. This is an invasive procedure that can cause complications.
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If your GERD-related heartburn symptoms cannot be controlled through medications or other treatments, the TIF procedure can improve your quality of life.