Transoral Incisionless Fundoplication (TIF)

  • What is Transoral Incisionless Fundoplication (TIF)?

    Transoral Incisionless Fundoplication is an endoscopic treatment designed to relieve symptoms of acid reflux (heartburn) and gastroesophageal reflux disease (GERD). TIF is one way to relieve GERD without the need for invasive surgery, and fundoplication refers to manipulating the lining of the stomach and esophagus to restore the body’s natural protection against acid in the esophagus.

  • What happens during a TIF procedure?

    During a TIF procedure, the endoscope is fed through a special TIF device that allows the endoscopist to reconstruct the anti-reflux valve between the stomach and the esophagus (the body’s natural barrier to reflux). It requires no incision and leaves no scar. Results are rapid, and patients can generally resume normal activities within a few days.

ARMS (anti-reflux mucosectomy)

In reflux disease (for example, GERD), the bottom of the esophagus is too loose, allowing too much food and fluid to reflux into the esophagus, causing heartburn, regurgitation, damage, ulcers, and even precancerous changes in the esophagus. An ARMS procedure removes the mucosa at the junction between the bottom of the esophagus and the top of the stomach. Patients may return to work the day after the procedure.

pH-Impedance testing and Bravo pH testing

The esophagus is a complex organ that requires specialized tests. The 24-hour pH impedance test is used to determine whether the patient has reflux disease (GERD). This involves a flexible and small catheter being inserted into the nose to reach the stomach. The 48-hour Bravo pH testing involves endoscopically placing a capsule into the lower esophagus to measure reflux and the degree of acidity.

Esophageal Manometry

Patients with difficulty or pain swallowing or chest pain not related to the heart be referred for a “motility study.” Esophageal manometry is a test that allows us to measure how the patient’s esophagus is contracting, how much, and how often. Patients must be awake for this procedure.

EndoFLIP (Endolumenal functional lumen imaging probe)

EndoFLIP is a new technique that measures the area across the lower esophagus and the pressure inside of it. The ratio is measured and called distensibility (or stiffness). During an upper endoscopy, the patient is sedated, and the endoscopist will place the catheter across the lower esophagus and into the stomach. The balloon is inflated with water, and pressure measurements are taken. The procedure is typically 10-15 minutes long. This is a great alternative when patients need an esophageal manometry test but cannot tolerate it or decline to do it because of discomfort.