TIF, Transoral Incisionless Fundoplication, is a novel acid reflux procedure performed through the mouth using an endoscope. It is marketed as a fundoplication but is it really a fundoplication? Is the gastric fundus (upper part of the stomach) mobilized during TIF procedure to be partially or completely wrapped around the esophagus?
During a Nissen Fundoplication, the Gold standard surgery for acid reflux, the gastric fundus is EXTENSIVELY and COMPLETELY mobilized. This dissection is a key component for Nissen surgery to be successful and durable. Unfortunately, the gastric fundus is not mobilized at all during TIF. In fact, the fundus remains in its original position after TIF procedure and is not folded around the esophagus. What actually happens during TIF is gastric tissue plication or approximation in the immediate vicinity of the distal esophagus. Hence, by definition, TIF is not a fundoplication.
Whether TIF is an effective and durable solution for acid reflux disease, your guess is better than mine. Quality long-term studies on TIF patients are still lacking. A randomized study by Dr. J. Hunter comparing TIF to daily Omeprazole (PPI) showed a 36% failure rate in achieving adequate symptom control 6 months after TIF. This is a high failure rate. Moreover, intra-esophageal pH (the objective study to measure acid reflux) was improved but not normalized after TIF. Despite careful patient selection in this study (mild acid reflux, small hiatal hernia, and no GERD related complications) TIF failure rate was quite high. Indeed, TIF does not offer significant advantage over high-dose antacid medications.
Clearly, TIF falls short of the acid reflux control a Nissen fundoplication offers. Houston Heartburn & Reflux Center does not recommend TIF as it is not a fundoplication, cannot fix a hiatal hernia or a shortened esophagus, and is associated with a high failure rate.