Long-term outcomes of transoral incisionless fundoplication for gastro-esophageal reflux disease: systematic-review and meta-analysis
Open Access
- 25 January 2021
- journal article
- review article
- Published by Georg Thieme Verlag KG in Endoscopy International Open
- Vol. 09 (02), E239-E246
- https://doi.org/10.1055/a-1322-2209
Abstract
Background and study aims Few reports exist about long-term outcomes of transoral incisionless fundoplication (TIF) for treating refractory gastro-esophageal reflux disease (GERD). Methods A literature search of four major scientific databases was performed up to May 2020 for studies reporting on more than 3-year outcomes of TIF. Data on atient satisfaction, proton pump inhibitor (PPI) daily consumption, PPI use reduction, GERD health-related quality-of-life (GERD-HRQL) score, and normalization of heartburn and regurgitation scores were pooled and summarized with forest plots. Publication bias and heterogeneity were explored. Results Overall, eight studies (418 patients, 232 men; 55.5 %) with a mean follow-up of 5.3 years (range: 3–10 years) were included. The pooled proportion of patient-reported satisfaction before and after TIF was 12.3 % (95 % CI:12.3–35.1 %, I2 = 87.4 %) and 70.6 % (95 % CI:51.2–84.6, I2 = 80 %), respectively, corresponding to an odds ratio of 21.4 (95 % CI:3.27–140.5). Pooled rates of patients completely off PPIs and on occasional PPIs were 53.8 % (95 %CI: 42.0 %-65.1 %) and 75.8 % (95 %CI: 67.6–82.6), respectively. The pooled estimated mean GERD-HRQL scores off PPI before and after TIF werey 26.1 (95 %CI: 21.5–30.7; range: 20.0–35.5) and 5.9, respectively (95 %CI:0.35.1–11.4; range: 5.3–9.8; P < 0.001). The overall pooled rates of heartburn and regurgitation scores normalization were 73.0 % (95 %CI: 0.62–0.82) and 86 %, respectively (95 %CI: 75.0–91.0 %). Conclusion Our study shows that TIF appears to offer a long-term safe therapeutic option for selected patients with GERD who refuse life-long medical therapy or surgery, are intolerant to PPIs, or are at increased surgical risk. Received: 15 July 2020 Accepted: 20 October 2020 Publication Date: 03 February 2021 (online) © 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/) Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, GermanyThis publication has 22 references indexed in Scilit:
- Trans-oral anterior fundoplication: 5-year follow-up of pilot studySurgical Endoscopy, 2015
- Use of proton pump inhibitors after antireflux surgery: a nationwide register-based follow-up studyGut, 2014
- Systematic review: Laparoscopic fundoplication for gastroesophageal reflux disease in partial responders to proton pump inhibitorsWorld Journal of Gastroenterology, 2014
- Three-Year Results of a Multicenter Prospective Study of Transoral Incisionless FundoplicationSurgical Innovation, 2012
- Transoral incisionless fundoplication for treatment of gastroesophageal reflux disease in clinical practiceSurgical Endoscopy, 2012
- Outlier and influence diagnostics for meta-analysisResearch Synthesis Methods, 2010
- The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and ElaborationPLoS Medicine, 2009
- Laparoscopic Nissen Fundoplication: Clinical Outcomes at 10 YearsJournal of the American College of Surgeons, 2007
- Measuring inconsistency in meta-analysesBMJ, 2003
- Assessing the quality of reports of randomized clinical trials: Is blinding necessary?Controlled Clinical Trials, 1996