Will TIF Procedure Correct or Cure Dysphagia?

Will TIF Procedure Correct or Cure Dysphagia?

Donald from Houston sent me this question few days ago. Dysphagia or difficult swallowing is common with acid reflux. Constant gastric content reflux into the esophagus damages esophageal motility leading to difficulty swallowing. It is no surprise that GERD patients, with years of heartburn and food regurgitation, present to our center with significant dysphagia symptoms. We routinely perform esophageal manometry testing prior to Nissen fundoplication surgery to evaluate esophageal motility, bolus clearance and lower esophageal sphincter pressure. In general, we advocate Nissen fundoplication or a 360 degree wrap for most of our acid reflux patients. The only absolute contraindication for a full wrap is a small gastric fundus that prevents us from performing a floppy Nissen fundoplication. Following Nissen fundoplication and complete cessation of acid reflux, esophageal motility improves and dysphagia resolves.

TIF or transoral incisionless fundoplication is not a fundoplication by any stretch of the imagination. It is a misnomer. Indeed, gastric fundus is not touched during TIF procedure. Rather, a small amount of gastric tissue is bunched up around the lower esophageal sphincter. The end result is limited, and short-term acid reflux control. Consequently, dysphagia secondary to acid reflux is not likely to resolve after TIF procedure.

Other causes of dysphagia include achalasia, esophageal cancer, peptic stricture… Dysphagia treatment in these cases depends on the underlying cause. For instance, laparoscopic Heller myotomy is offered for achalasia patients and obviously TIF procedure has no role in these cases.