P140 Transoral incisionless fundoplication using the EsophyX Z+ device: a UK first experience

Introduction

Gastroesophageal reflux disease (GORD) is becoming increasingly prevalent in the western world. Lifestyle modification and medical therapy remain first line interventions, although anti-reflux surgery remains a choice in select individuals. Advances in endoscopic anti-reflux procedures have shown promise as an additional treatment option. Here we present the first UK experience of treating patients with confirmed GORD with Transoral incisionless fundoplication (TIF) 2.0 using the EsophyX Z+ device.

Methods

Data was collected retrospectively from 46 patients who underwent TIF 2.0 between November 2019 and February 2022 at a specialist centre. GERD-Health-Related Quality of Life (GERD-HRQL) questionnaires were used to evaluate treatment response.

Results

TIF 2.0 was performed in 46 patients, (29 male and 17 Female). The mean patient age at the time of procedure was 50 ± 17.3 years. Baseline physiology metrics following 96-hour BRAVO^TM reflux testing were available for 38 patients. The mean DeMeester score at baseline was 31.62 ± 15.4. The median acid exposure time (% time pH <4) was 8.52% (IQR: 5.5% - 10.9%) Pre and post procedure quality of life metrics were available for 17 patients at the time of the analysis (Table 1). Mean follow up was 197 days post TIF (Range 47-618 days). 7/17 patients had discontinued PPI post procedure. Two patients developed post procedure nausea and vomiting requiring inpatient admission and management with IV hydration and anti-emetics. One patient required balloon dilatation for symptomatic dysphagia. The most frequently reported side effect following TIF was abdominal pain (48%; 22/46); however, this was mostly mild and resolved with simple analgesics.

Conclusions

This represents UK’s first experience of TIF 2.0. Our growing cohort of patients undergoing TIF corroborates recent published data showing that it is a safe and effective procedure. Further, in patients in whom we have follow up data, there is a clear improvement in quality-of-life metrics, thus highlighting its potential as a viable endoscopic treatment option for patients with troublesome GORD. Limitations to this study are the retrospective observational design, heterogenous follow up data with the possibility of self-selection bias in follow up questionnaires. This may impact the generalisability of results. Further collection of outcomes using standardised study protocols with a larger patient cohort from different centres will help build upon the UK experience.