Kenneth J. Chang, MD, FASGE, FACG, AGAF, FJGESa, Reginald Bell, MD, FACS.
Gastrointest Endoscopy Clin N Am 30 (2020) 267–289 1052-5157/20/


On the GERD spectrum, TIF may be a treatment option among patients with GERD with anintact and functioning crura, but would benefit from strengthening, tightening, and length-ening the LES complex. Therefore, patient selection is very important in determining whichpatients will likely have the best outcome.

As an endoscopic procedure, TIF reduces EGJ distensibility, thereby decreasing tLESRs,and also creates a 3-cm high-pressure zone at the distal esophagus in the configuration ofa flap valve.

Level 1 evidence confirms both the safety and efficacy of TIF 2.0, especially in patientswho have troublesome regurgitation despite PPI therapy.

The concomitant laparoscopic hernia repair with TIF for those patients with hiatal herniagreater than 2 cm is now emerging as a potential strategy within laparoscopic antirefluxsurgery.

Future potential applications that are currently being investigated include the use of TIF in(1) patients with Barrett’s esophagus; (2) patients with achalasia after per-oral endoscopicmyotomy; (3) bariatric patients before and after laparoscopic sleeve gastrectomy; and (4)patients after lung transplant.

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