Evidence map›Paper›PMID 36650353›Full record

ArticleSurgical endoscopy2023

Transoral incisionless fundoplication for recurrent symptoms after laparoscopic fundoplication.

Gaurav Ghosh, Alyssa Y Choi, Mohamad Dbouk, Jacques Greenberg, Rasa Zarnegar, Michael Murray, Peter Janu, Nirav Thosani, Barham K Abu Dayyeh, David Diehl and 5 more

Abstract readMulticenter Study
PubMed Publisher
In one paragraph

Article in Surgical endoscopy, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
2.8field-weighted citation impact, top 11% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it, 10 citations in OpenAlex.

  1. Pooled it
  2. Review
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors at 7 institutions in 1 country.

Gaurav Ghosh *Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, 1283 York Ave, 9th Floor, New York, NY, 10065, USA. gghosh010@gmail.com.ORCID 0000-0002-8558-8098
Alyssa Y Choi *HH Chao Comprehensive Digestive Disease Center, University of California Irvine Medical Center, Orange, CA, USA.
Mohamad DboukDivision of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Jacques GreenbergDepartment of Surgery, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA.
Rasa ZarnegarDepartment of Surgery, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA.
Michael MurrayNorthern Nevada Medical Group, Fallon, NV, USA.
Peter JanuFox Valley Surgical Associates, Affinity Health Systems, Appleton, WI, USA.
Nirav ThosaniCenter for Interventional Gastroenterology at UTHealth, McGovern Medical School, UTHealth, Houston, TX, USA.
Barham K Abu DayyehDivision of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
David DiehlDepartment of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, PA, USA.
Ninh T NguyenDepartment of Surgery, University of California Irvine Medical Center, Orange, CA, USA.
Kenneth J ChangHH Chao Comprehensive Digestive Disease Center, University of California Irvine Medical Center, Orange, CA, USA.
Marcia Irene CantoDivision of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Reem SharaihaDivision of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, 1283 York Ave, 9th Floor, New York, NY, 10065, USA.
TIF Research Consortium
NewYork–Presbyterian Hospital · USUniversity of California, Irvine Medical Center · USJohns Hopkins University · USFox Valley Surgical Associates · USGeisinger Medical Center · USMayo Clinic in Arizona · USThe University of Texas Health Science Center at Houston · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundRevision of a failed laparoscopic fundoplication carries higher risk of complication and lower chance of success compared to the original surgery. Transoral incisionless fundoplication (TIF) may be an endoscopic alternative for select GERD patients without need of a moderate/large hiatal hernia repair. The aim of this study was to assess feasibility, efficacy, and safety of TIF 2.0 after failed laparoscopic Nissen or Toupet fundoplication (TIFFF).

methodsThis is a multicenter retrospective cohort study of patients who underwent TIFFF between September 2017 and December 2020 using TIF 2.0 technique (EsophyX Z/Z+) performed by gastroenterologists and surgeons. Patients were included if they had (1) recurrent GERD symptoms, (2) pathologic reflux based upon pH testing or Grade C/D esophagitis or Barrett's esophagus, and (3) hiatal hernia ≤ 2 cm. The primary outcome was improvement in GERD Health-Related Quality of Life (GERD-HRQL) post-TIFFF. The TIFFF cohort was also compared to a similar surgical re-operative cohort using propensity score matching.

resultsTwenty patients underwent TIFFF (median 4.1 years after prior fundoplication) and mean GERD-HRQL score improved from 24.3 ± 22.9 to 14.75 ± 21.6 (p = 0.014); mean Reflux Severity Index (RSI) score improved from 14.1 ± 14.6 to 9.1 ± 8.0 (p = 0.046) with 8/10 (80%) of patients with normal RSI (< 13) post-TIF. Esophagitis healed in 78% of patients. PPI use decreased from 85 to 55% with 8/20 (45%) patients off of PPI. Importantly, mean acid exposure time decreased from 12% ± 17.8 to 0.8% ± 1.1 (p = 0.028) with 9/9 (100%) of patients with normalized pH post-TIF. There were no statistically significant differences in clinical efficacy outcomes between TIFFF and surgical revision, but TIFFF had significantly fewer late adverse events.

conclusionEndoscopic rescue with TIF is a safe and efficacious alternative to redo laparoscopic surgery in symptomatic patients with appropriate anatomy and objective evidence of persistent or recurrent reflux.

Indexed as

EsophagitisGastroesophageal RefluxLaparoscopyFundoplicationHumansQuality of LifeRetrospective StudiesTreatment OutcomeGastroesophageal reflux diseaseGERDHiatal herniaNissen fundoplicationProton pump inhibitorTransoral incisionless fundoplication

Identifiers

PMID36650353
OpenAlexW4317035082

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.