Long-term outcomes of transoral incisionless fundoplication for gastro-esophageal reflux disease: systematic-review and meta-analysis

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%, I-2=87.4%) and 70.6% (95% CI:51.2-84.6, I-2=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.