Dr. Starpoli's Blog

A Beginner's Guide to TIF for GERD: Everything to Know

Posted by Anthony A. Starpoli, MD on Jan 25, 2021 12:35:17 AM

Chest pain, burning sensations beneath the breast bone known has heartburn, and constant burping brings no one joy.  Gastroesphageal reflux disease (GERD) patients fully understand this pain and discomfort. 

If you've ever felt the chest pressure and acidic pain that comes from GERD, you'll appreciate knowing there's an available procedure that can offer a long-term solution. You do not have to rely on your little purple pill for the rest of your life. 

Transoral incisionless fundoplication, known as TIF, is a non-surgical, endoscopic procedure that is bringing thousands of GERD patients long-term relief. Keep reading to learn everything you need to know about TIF for GERD. 

How Does TIF for GERD Work? 

TIF is an endoscopic procedure, which means the doctor goes in through your mouth and directs a scope or tube with a camera at its tip down into your stomach. The TIF procedure offers long-term relief from acid reflux or heartburn associated with GERD. 

TIF is not a surgical treatment. It does not require an external incision. Everything is done through the mouth to work within the esophagus and stomach. As a result, patients endure a shorter procedure with less pain and a quicker recovery than past traditional surgical solutions have offered. 

Endoscope, Not Laparoscope

An endoscope is not a laparoscope. An endoscope is an instrument used mostly by gastroenterologist (doctors trained to treat the GI tract) to see inside the GI tract such as the esophagus and stomach.  It is a flexible tube with a camera at its tip that is introduced through the mouth.

Laparoscopes are similar in that they see inside the body as well. However, with a laparoscopic procedure, a doctor pokes a hole through the abdominal wall and works on the organs such as the esophagus from the outside, but within the abdominal cavity. Laparoscopes are straight non-flexible scopes with a camera.  Laparoscopic surgery is a traditional surgical technique because it requires an incision through the skin. 

An endoscope does not require an incision. Thus, patients recover much more quickly than with a traditional surgical procedure. 

The Steps of a TIF Procedure

When you have GERD, acid flows from your stomach back into your esophagus, causing chest pain and a burning sensation. With the TIF procedure, the doctor repairs or recreates a new natural barrier to reflux. 

The TIF procedure works especially well for patients with heartburn or regurgitation after eating. 

Here's how a doctor performs a TIF procedure: 

  1. You receive anesthesia to make you sleepy. 
  2. The endoscopic surgeon uses the TIF to guide an endoscope into your mouth, down your throat, through the esophagus and into your stomach. 
  3. Once in your stomach, the doctor flips the endoscope up so they can see the opening of both your esophagus and stomach. 
  4. The doctor grabs the end of your esophagus with the TIF device, bringing it down and wrapping the top of your stomach approximately 270 degrees around the esophagus. They create a new valve with this move. 
  5. The valve is secured with plastic (nylon) fasteners that remain in your body. 
  6. The TIF device and endoscope are removed.  

The procedure is simple and  takes less than an hour to complete.  You can usually leave the hospital the same day.

What to Expect After the Procedure

After the TIF procedure, patients receive antibiotics for two to three days and medications for symptom relief. 

You should also expect to take in only clear liquids for the first 24 hours and to take in just liquids for the first full week after the procedure. Then you can progress to thicker liquids and soft foods over the subsequent 4-6 weeks as tolerated. 

You should plan on no heavy activity for the first few weeks after surgery. You can then progress to modified activities until the fifth week. After 6 weeks of modified activity, you can usually resume full activity that includes significant lifting. 

You will experience some basic side effects from the surgery including a sore throat, some shoulder pain, and, perhaps, a minimal amount chest pain or abdominal discomfort.  These symptoms usually do not require any serious pain medications

What Are the Side Effects of GERD? 

Side effects of surgery sound scary. But the side effects of untreated GERD are more frightening. 

GERD begins as a burning sensation in your chest or maybe even some chest pain that feels like pressure. You will have difficulty swallowing and possibly regurgitate food or sour liquid regularly. You may even feel a sensation of a lump in your throat. 

The acid that splashes into your esophagus will eventually lead to bleeding, which can then progress into your digestive tract and cause dark, tarry stools. You can also develop ulcers in your esophagus, which can potentially lead to cancer of the esophagus.   

Cost-Benefit Analysis

A TIF procedure will cost you time and money. However, your insurance may cover the procedure. Check with your health insurance agent.

The benefits of TIF far outweigh the risk, especially if you've lived with GERD for years. The treatment has proven to be a longterm solution for individuals who have relied on medication for years.

Am I a Good Candidate For the TIF Procedure? 

Whether you've suffered from GERD for a month or years, you may wonder if you're a good candidate for the TIF procedure. You qualify as a good candidate if you answer yes to these questions. 

  1. Do you take medicine? Have you changed your diet? Do you still have symptoms? 
  2. Have you had to increase your dosage to control your symptoms? 
  3. Do you have problems like a cough or asthma-like symptoms even though the medicine controls your heartburn? 
  4. Do you want to not rely on long-term acid-reducing medications? 

Your anatomy will determine your candidacy as well. For example, a doctor can use a TIF to help correct a small hiatal hernia as well. If you have a large hernia, though, you may need formal surgery to correct the hernia before you have the TIF procedure.

Why Not Just Use Medication For GERD? 

Newer GERD treatments like the Stretta procedure and the TIF procedure are proving to be a long-term solution with fewer side effects. Symptoms such as regurgitation often do not respond to drug therapy, but do improve or resolve after procedural therapy. We do not know the side effects of long-term proton pump inhibitor use, the common pharmaceutical treatment for GERD. There is data that suggests PPI therapy may place persons at a greater risk for more severe Covid-19 illnesses.

The majority of TIF-procedure patients were able to stop taking their daily dose of PPIs (proton pump inhibitors). Furthermore, 75 percent said they did not have any heartburn one year after the TIF procedure. 

Longterm Solution to GERD

TIF for GERD is a longterm solution to a serious problem. 

If you've struggled with GERD, schedule an appointment with Dr. Starpoli in Poughkeepsie, NY or Manhattan today. A pill-free existence is in your future. 

Reflux, acid reflux, TIF, GERD, GERD Awareness Week