TY - JOUR
T1 - Response of Laryngopharyngeal Symptoms to Transoral Incisionless Fundoplication in Patients with Refractory Proven Gastroesophageal Reflux
AU - Snow, Grace E.
AU - Dbouk, Mohamad
AU - Akst, Lee M.
AU - Ihde, Glenn
AU - Zarnegar, Rasa
AU - Janu, Peter
AU - Murray, Michael
AU - Eskarous, Hany
AU - Sohagia, Amit
AU - Dhar, Shumon I.
AU - Irene Canto, Marcia
N1 - Funding Information:
We thank Jessica Duchen from the Biostatistics, Epidemiology and Data Management Core (BEAD), Johns Hopkins University School of Medicine, Baltimore, Maryland, for her assistance in data management. We thank Dr. Kenneth Chang from the Division of Gastroenterology, University of California in Irvine, California, for his assistance with study design and collection of data. We thank Dr. Ninh Nguyen from the Department of Surgery, University of California in Irvine, California, for his assistance with collection of data and reviewing the manuscript. We thank Dr. Christy Dunst from the Department of Surgery, The Oregon Clinic, Portland, Oregon for her assistance in reviewing and revising the manuscript. We thank Dr. Reem Sharaiha from the Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York, for her assistance in reviewing the manuscript. We thank Dr. Nirav Thosani from the Division of Gastroenterology, McGovern Medical School-UTHealth, Houston, Texas, for his assistance with study design and collection of data. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The research was supported in part by a grant from Endogastric Solutions for the investigator-initiated prospective TIF Registry. The study design and execution, authorship and publication of this article were completed independent of Endogastric Solutions.
Funding Information:
The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Peter Janu is a consultant for EndoGastric Solutions, Ethicon, Johnson and Johnson, and Olympus. Dr. Marcia Canto received a grant from Endogastric Solutions for the investigator-initiated prospective TIF Registry, received research grants from Lucid Diagnostics and Pentax Medical Corporation, and receives royalties from UpToDate.
Publisher Copyright:
© The Author(s) 2021.
PY - 2022/6
Y1 - 2022/6
N2 - Objective: Patients with laryngopharyngeal reflux (LPR) symptoms may not respond to proton pump inhibitors (PPI) if they have an alternative laryngeal diagnosis or high-volume reflux. Transoral incisionless fundoplication (TIF) or TIF with concomitant hiatal hernia repair (cTIF) are effective in decreasing symptoms of gastroesophageal reflux disease (GERD) but are not well studied in patients with LPR symptoms. This prospective multicenter study assessed the patient-reported and clinical outcomes after TIF/cTIF in patients with LPR symptoms and proven GERD. Methods: Patients with refractory LPR symptoms (reflux symptom index [RSI] > 13) and with erosive esophagitis, Barrett’s esophagus, and/or pathologic acid reflux by distal esophageal pH testing were evaluated before and after a minimum of 6 months after TIF/cTIF. The primary outcome was normalization of RSI. Secondary outcomes were >50% improvement in GERD-Health-Related Quality of Life (GERD-HRQL), normalization of esophageal acid exposure time, discontinuation of PPI, and patient satisfaction. Results: Forty-nine patients had TIF (n = 26) or cTIF (n = 23) with at least 6 months follow-up. Mean pre- and post TIF/cTIF RSI were 23.6 and 5.9 (mean difference: 17.7, P <.001). Post TIF/cTIF, 90% of patients had improved GERD-HQRL score, 85% normalized RSI, 75% normalized esophageal acid exposure time, and 80% discontinued PPI. No serious procedure-related adverse events occurred. Patient satisfaction was 4% prior to TIF/cTIF and 73% after TIF/cTIF (P <.001). Conclusion: In patients with objective evidence of GERD, TIF, or cTIF are safe and effective in controlling LPR symptoms as measured by normalization of RSI and improvement in patient satisfaction after TIF/cTIF. Level of Evidence: Level 4.
AB - Objective: Patients with laryngopharyngeal reflux (LPR) symptoms may not respond to proton pump inhibitors (PPI) if they have an alternative laryngeal diagnosis or high-volume reflux. Transoral incisionless fundoplication (TIF) or TIF with concomitant hiatal hernia repair (cTIF) are effective in decreasing symptoms of gastroesophageal reflux disease (GERD) but are not well studied in patients with LPR symptoms. This prospective multicenter study assessed the patient-reported and clinical outcomes after TIF/cTIF in patients with LPR symptoms and proven GERD. Methods: Patients with refractory LPR symptoms (reflux symptom index [RSI] > 13) and with erosive esophagitis, Barrett’s esophagus, and/or pathologic acid reflux by distal esophageal pH testing were evaluated before and after a minimum of 6 months after TIF/cTIF. The primary outcome was normalization of RSI. Secondary outcomes were >50% improvement in GERD-Health-Related Quality of Life (GERD-HRQL), normalization of esophageal acid exposure time, discontinuation of PPI, and patient satisfaction. Results: Forty-nine patients had TIF (n = 26) or cTIF (n = 23) with at least 6 months follow-up. Mean pre- and post TIF/cTIF RSI were 23.6 and 5.9 (mean difference: 17.7, P <.001). Post TIF/cTIF, 90% of patients had improved GERD-HQRL score, 85% normalized RSI, 75% normalized esophageal acid exposure time, and 80% discontinued PPI. No serious procedure-related adverse events occurred. Patient satisfaction was 4% prior to TIF/cTIF and 73% after TIF/cTIF (P <.001). Conclusion: In patients with objective evidence of GERD, TIF, or cTIF are safe and effective in controlling LPR symptoms as measured by normalization of RSI and improvement in patient satisfaction after TIF/cTIF. Level of Evidence: Level 4.
KW - gastroesophageal reflux disease
KW - laryngopharyngeal reflux
KW - transoral incisionless fundoplication
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UR - http://www.scopus.com/inward/citedby.url?scp=85112318951&partnerID=8YFLogxK
U2 - 10.1177/00034894211037414
DO - 10.1177/00034894211037414
M3 - Article
C2 - 34378427
AN - SCOPUS:85112318951
SN - 0003-4894
VL - 131
SP - 662
EP - 670
JO - Annals of Otology, Rhinology and Laryngology
JF - Annals of Otology, Rhinology and Laryngology
IS - 6
ER -