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, which is 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.
The TIF Procedure
On the day of your procedure, you'll be asked to arrive an hour or so early for preparation. You'll be given an IV with medication to make you sleepy, and the procedure will take 45 minutes or less.
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.
Who Benefits from the TIF Procedure?
Medications known as proton pump inhibitors are often considered the treatment of choice for people with early and moderate chronic 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.
The TIF procedure may be right for you if:
- You have typical GERD symptoms that have not responded well to proton pump inhibitors.
- You have GERD symptoms and a mild to moderate abnormality of the gastroesophageal junction valve between your stomach and esophagus.
- You are seeking an alternative to the long-term use of medications to control your GERD symptoms.
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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.