Efficacy and safety of transoral incisionless fundoplication in non-obese and obese adults: a population-based cohort study from the United States - Scorecard - MDSpire
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Efficacy and safety of transoral incisionless fundoplication in non-obese and obese adults: a population-based cohort study from the United States
Clinical Scorecard: Effectiveness and safety of transoral incisionless fundoplication in adults with varying body weights: findings from a U.S. population-based cohort study
At a Glance
Category
Detail
Condition
Gastroesophageal reflux disease (GERD)
Key Mechanisms
Transoral incisionless fundoplication (TIF) repairs the anti-reflux barrier via flap valve reconstruction, restoring the angle of His, and augmenting the high-pressure zone at the lower esophageal sphincter.
Target Population
Adults aged ≥ 18 years with chronic symptomatic GERD
Care Setting
U.S. population-based cohort study using electronic medical records
Key Highlights
TIF is effective for patients with axial hernia < 2 cm or hiatus diameters < 3 cm.
TIF has comparable efficacy to surgical fundoplication in appropriately selected patients.
BMI ≥ 35 kg/m2 is a relative contraindication for TIF.
Class 1 obesity (BMI 30–34.9 kg/m2) represents a significant cohort of GERD patients.
Combining TIF with cruroplasty shows comparable short-term efficacy and excellent safety.
Guideline-Based Recommendations
Diagnosis
Diagnosis of GERD should be confirmed using validated ICD-10 codes.
Management
Consider TIF for patients with axial hernia < 2 cm or hiatus diameters < 3 cm.
Monitoring & Follow-up
Monitor for postoperative new PPI recidivism and incidence of post-TIF esophagitis.
Risks
Higher fundoplication failure rates with increasing BMI and potential for perioperative complications.
Patient & Prescribing Data
Adults with GERD stratified by BMI: non-obese (BMI < 30 kg/m2) and class I obesity (BMI 30–34.9 kg/m2).
TIF may be effective in class I obesity, but BMI ≥ 35 kg/m2 is a contraindication.
Clinical Best Practices
Perform one-to-one propensity score matching to minimize confounding.
Assess covariate balance post-matching to ensure comparability between BMI cohorts.
by Fouad Jaber, Saltenat Moghaddam Adames, Mohamed Jaber, Kinan Obiedat, Kalpesh Patel, Teminioluwa A. Ajayi, Roy Tomas DaVee, Fares W. Ayoub, Nirav Thosani, Wasseem Skef
