Patient info for TIF/endoscopic gastric fundoplication
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A new surgical technique for acid reflux No incisions!
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Patient info for TIF/endoscopic gastric fundoplication
- 8. Continued Reflux Symptoms on Medications Gallup Poll Reflux* 72% on Medication 79% Nighttime symptoms 50% Nighttime reflux worse than daytime reflux 63% Ability to sleep affected 40% Daytime function affected 70% Nighttime discomfort moderate to severe 75% Can not fall asleep or wakes them up 45% Medication does not relieve all symptoms *Gallup Poll 2000 for AGA N = 1000 American Journal of Gastroenterology 2003; vol. 98 Shaker et al 20-40% of patients dissatisfied with PPI medication
- 12. EsophyX Animation Unique Surgical Approach
- 15. Phase 2 – Dietary Changes * P < 0.01 Patients can enjoy foods that caused reflux off PPIs
- 16. Phase 2 – Dietary Changes Patients can enjoy more foods than they could on PPIs without reflux
Editor's Notes
- Here is an animated video of the EsophyX ELF procedure. The device rides over a standard endoscope. One technical challenge is that the device needs to be flexible and soft to make the 90 degree bend in the throat, then stiff and strong to perform surgery in the stomach. The endoscope is always introduced first so that the entire procedure is performed under visual control. The stomach is insufflated and the endoscope is placed in retroflex view. Under visual control, the device is advanced into the stomach. Before creating the valve, the anatomy needs to be in the correct configuration, so any hiatal hernia is reduced first. To do this, the endoscope is retracted back into the EsophyX device up to the clear window in the shaft of the device. Through this window the z-line is visualized. Once located, the invaginator is engaged which uses suction to bring the esophagus onto the shaft of the device. The device is advanced to elongate the esophagus, bringing the z-line to the level of the diaphragm, thus reducing hiatal hernia. Now that the anatomy is in the correct configuration, the valve can be created. The endoscope is advanced and returned to retroflex view. The tissue mold is partially closed, and the helical retractor is advanced out the tip of the tissue mold and twisted to engage it in the fundus tissue. The mold is opened out of the way and a long flap of tissue is pulled down (3-5 cm long flap). The flap mold is closed to compress the tissue and fasteners are delivered across the top of this length of tissue. This shows a close up of the fastener delivery, with the sylet pushing across, and the trailing leg, then lead leg of the H fastener dropping, as the fastener is pushed until it drops off the stylet. These are tension-free fasteners, because they do not put tension on the tissue in any one place. 2 fasteners (one posterior and one anterior) can be delivered at any one placement of the tissue mold. The system is disengaged, you move to a new location of the valve and repeat this procedure until a 270-310 degree circumference, tight valve has been created.