Transoral Incisionless Fundoplication for patients with Gastroesophageal Reflux Disease after Peroral Endoscopic Myotomy: a prospective cohort

BACKGROUND AND STUDY AIMS Achalasia is a condition related to the failure of relaxation of the lower esophageal sphincter (LES). Treatment is based on reducing LES pressure. While treatment is traditionally surgical, poor candidates for this modality may be treated with peroral endoscopic myotomy (POEM). However, POEM is associated with a relatively high incidence of gastroesophageal reflux disease (GERD). For cases refractory to proton pump inhibitors (PPIs), transoral incisionless fundoplication (TIF) is one of the endoscopic therapies proposed. PATIENTS AND METHODS This was a pilot single-center prospective cohort study including ten patients with post-POEM GERD refractory to clinical management who underwent endoscopic treatment with the TIF procedure between February and November 2021. We included patients ≥ 18 years old who developed GERD after POEM. RESULTS Technical success was achieved in all ten cases treated with TIF. In the 6-month and 12-month follow-up, 7 (70%) patients reduced PPI use. Two patients (20%) had no esophagitis initially, increasing to five (55%) at 6 months and four (44%) at 12 months. The symptoms evaluation and GERD-HRQL questionnaire showed a significant score reduction at 6 months and a downward trend at 12 months. The mean Eckardt score showed a decreasing trend although mean dysphagia score showed a slight tendency to increase in one year. The procedure was considered safe, with no adverse event. CONCLUSIONS The use of TIF seems to be a feasible alternative in treating GERD after POEM, improving both clinical and endoscopic parameters and pHmetry in a considerable percentage of cases.