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

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.

Related Resources & Content

1. Obesity Surgery, 2025 -- Surgical Options for Managing GERD in Individuals with Moderate Obesity: Comparing Fundoplication and Roux-en-Y Gastric Bypass

2. Journal of Gastrointestinal Surgery, 2021 -- Laparoscopic Fundoplication Demonstrates Efficacy in Treating Gastroesophageal Reflux in Patients with Impaired Esophageal Motility

3. Obesity Surgery, 2025 -- Safety Profiles of Roux-en-Y Gastric Bypass and Sleeve Gastrectomy in Patients with Prior Fundoplication: An Analysis of 499 Cases from MBSAQIP

4. ASGE guideline on the diagnosis and management of GERD: summary and recommendations

5. Obesity Surgery — Factors Influencing the Effectiveness of Endoscopic Sleeve Gastroplasty

6. ASGE | American Society for Gastrointestinal Endoscopy guideline on the diagnosis and management of GERD: summary and recommendations

7. Transoral Incisionless Fundoplication Effective in Eliminating GERD Symptoms in Partial Responders to Proton Pump Inhibitor Therapy at 6 Months: The TEMPO Randomized Clinical Trial - PMC

8. Does Transoral Incisionless Fundoplication (TIF. 2.0) Improve Atypical GERD Symptoms? A Systematic Review and Meta-Analysis - PMC