Use of peroral endoscopic myotomy (POEM) for achalasia is associated with a high rate of post-procedural gastroesophageal reflux (GER). It appears that transoral incisionless fundoplication (TIF) may serve as an ideal endoscopic treatment. Gutierrez and colleagues conducted a multicenter retrospective study which included post-POEM patients with GER who underwent TIF. The study endpoints included technical success, safety and effectiveness (change in symptoms, scores, proton pump inhibitor [PPI] use, pH studies).Overall, 12 patients underwent TIF following POEM. Nine of the patients had daily symptoms, with 91.7% requiring twice daily PPIs. •    Technical success was attained in all the patients. •    Two adverse events were reported. •    Significant reductions were noted in the percentage of patients on twice daily PPIs, frequency of daily symptoms, Reflux Severity Index questionnaire, and GERD Health-related Quality of Life scores. •    pH studies done in 7 patients exhibited a significant decrease in the mean DeMeester score and mean percentage acid exposure time.

The results suggest that TIF might be effective and safe to treat post-POEM GER. 

Source: Gutierrez OIB, Chang KJ, Benias PC, et al. Is transoral incisionless fundoplication (TIF) an answer to post-peroral endoscopic myotomy gastroesophageal reflux? A multicenter retrospective study. Endoscopy. 2022 Mar;54(3):305-309.