TIF^® Procedure

Chronic heartburn doesn’t have to mean a lifetime of medication or a more invasive traditional surgery. For patients whose GERD persists despite lifestyle changes and medication, the TIF^® procedure offers a minimally invasive, incisionless alternative using EsophyX^® technology, performed entirely through the mouth with no external incisions required.

• What Is the TIF^® Procedure?
• TIF^® Benefits
• TIF^® Candidates
• TIF^® Procedure
• TIF^® Recovery
• TIF^® Results
• TIF^® Risks

What Is the TIF^® Procedure?

The Transoral Incisionless Fundoplication (TIF^®) procedure using EsophyX^® technology is a minimally invasive treatment for gastroesophageal reflux disease (GERD). It works by reconstructing the valve at the base of the esophagus as well as reducing a hiatal hernia to create a tighter opening that can prevent stomach reflux. This innovative procedure uses a transoral approach, which can completely eliminate reflux symptoms in some patients. By using this advanced approach, the device is inserted through the mouth to access the stomach, and no incisions are used.

What Are the Benefits of the TIF^® Procedure?

The TIF^® procedure offers several advantages over traditional surgical approaches to treating GERD:

• No incisions are needed, so post-operative wound care is not involved during recovery
• Fewer complications compared to traditional acid reflux procedures
• Performed on an outpatient basis, so most patients return home the same day
• No external scarring, since the device is inserted through the mouth
• Often a quicker return to normal activities than with more invasive procedures

Am I a Candidate for the TIF^® Procedure?

For optimal GERD treatment and minimal side effects, our doctors will carefully select candidates who are likely to achieve successful results. In general, this includes patients who can identify with the following:

• 18 years or older
• Chronic GERD
• Hiatal hernia 2 cm or smaller
• BMI of under 35

In addition, patients should not have any medical conditions that could affect post-operative healing. More personalized details about an individual’s candidacy will be discussed during the consultation process.

Patients with a larger hiatal hernia (greater than 2 cm) may still be candidates through a combined approach, known as cTIF, where TIF is performed alongside laparoscopic hiatal hernia repair.¹ This option is recognized in updated national guidelines on GERD management.

How Does the TIF^® Procedure Work?

The TIF^® procedure is performed under general anesthesia in an outpatient setting. It utilizes EsophyX^® technology that has been specially designed for altering the esophageal valve to create a partial fundoplication. This involves wrapping the upper portion of the stomach around 270 degrees of the esophagus.

To begin the procedure, a flexible endoscope is inserted into the EsophyX^® device, which allows the surgeon to visualize every step of the process. The device is then gently inserted through the mouth and guided into the stomach. Due to this transoral approach, no incisions are created. The stomach is then inflated, creating space for the device and endoscope to be retroflexed back towards the esophagus.

The EsophyX^® tool then pulls the gastroesophageal junction down into its tissue mold, and the device is slightly rotated. During this time, a small hiatal hernia can be reduced using suction created by the device. To secure this retracted tissue to the outside of the esophagus, non-absorbable fasteners (composed of strong polypropylene material) are placed in pairs around the valve. Approximately 20 fasteners are typically required. This process of retracting, rotating, and securing the tissue is repeated until an omega-shaped valve is created.

What Is Recovery Like After the TIF^® Procedure?

Because no incisions are made, patients typically experience a shorter, more comfortable recovery than with traditional surgery. Over the course of the following weeks, fibrous tissue develops in the area, and the tissue surrounding the valve fuses, helping secure a full thickness partial fundoplication. Most patients are able to gradually return to a normal diet and daily activities as this healing process takes place.

What Are the Results of the TIF^® Procedure?

The valve created by the TIF^® procedure has proven effective and durable in long-term clinical studies. In select patients, the TIF^® procedure has been reported to significantly reduce or eliminate GERD symptoms.²

What Are the Risks of the TIF^® Procedure?

As with any procedure involving anesthesia, there are risks related to bleeding, infection, and reaction to anesthesia. Risks and side effects more specific to the TIF^® procedure may include:

• Difficulty or discomfort swallowing
• Gas, bloating, or excess burping
• Chest pain or soreness
• Nausea or vomiting
• Sore throat
• In rare cases, esophageal or gastric perforation
• Possibility that symptoms return over time, which may require additional treatment

Most side effects are temporary and improve within the first few weeks after the procedure. Your surgeon will review your individual risk factors during your consultation.

Medical Resources

¹American Society for Gastrointestinal Endoscopy guideline on the diagnosis and management of GERD: summary and recommendations
²Diseases of the Esophagus: Long-term benefit of transoral incisionless fundoplication using the EsophyX device for the management of gastroesophageal reflux disease responsive to medical therapy