The TIF Procedure: A Nonsurgical GERD Treatment

When you have GERD, your symptoms are often due to a malfunctioning gastroesophageal (GE) junction valve. A properly working valve is like a cover that keeps acid where it should be.

The TIF procedure involves creating a stronger, more supportive band of tissue around the area where the stomach meets the esophagus. A doctor who specializes in gastrointestinal procedures, called a gastroenterologist, performs the procedure.

Here are the basic steps of the TIF procedure:

1. You will receive anesthesia medications to ensure you’re asleep and unaware while the procedure is taking place.
2. Your doctor will insert the gastroscope (a endoscopic tool used to view the stomach) inside your mouth to view your esophagus and stomach.
3. Your doctor will identify the key anatomy (your stomach and esophagus). They’ll use their tools to wrap the gastric fundus (a top piece of your stomach) around your esophagus.
4. Your doctor will then deploy special fasteners to secure the newly created valve.
5. The TIF procedure is complete and your doctor will remove their tools.

The overall effect is to create a stronger barrier so acid can’t come up and cause GERD symptoms.

How long does the TIF procedure take?

You should plan to set aside the entire day for your procedure, no matter what time it’s scheduled for.

You’ll typically be asked to arrive at the hospital at least an hour before your procedure, if not more. The procedure itself should not last more than hour.

Your surgical team will have more details for you on when you’ll need to be there and how to prepare.

Immediately following your procedure, you will stay in the hospital for a short observation period. Most people are discharged within 24 hours with instructions to call their doctor if they have unwanted symptoms or complications.

The TIF procedure has evolved since surgeons first performed it in Europe in 2005. Specifically, in 2017, medical device manufacturers launched the EsophyX Z. Doctors use this device to launch fasteners to connect the top part of the stomach to the lower esophageal sphincter (the bottom portion of your esophagus).

Because the TIF procedure is a fairly new approach, there aren’t a lot of long-term studies about the procedure’s effectiveness. However, a study in 2019 found that about 42 percent of patients didn’t need to take PPIs (aka proton pump inhibitors) for up to 10 years after surgery.

A 2020 study following patients for 5 years after having a TIF procedure found that more than 75 percent reported satisfaction with the procedure and decreased PPI use.

A few factors have been shown to increase the likelihood that a TIF procedure will successfully reduce GERD symptoms. They include:

• high scores on the GERD-HQL questionnaire before surgery (a person typically has a low score if they have a poor quality of life with GERD)
• high use of PPI medications before surgery
• being over age 50

If the TIF procedure effectively treats your GERD, there are several possible benefits:

• a reduced need to take medications to treat GERD
• less bloating
• healed esophagitis (irritation of the lining of your esophagus)

Before your doctor will schedule a TIF procedure, they will likely recommend several testing methods to ensure you’re a good candidate for the procedure.

Examples include:

• Evaluating your acid reflux history, overall medical history, and medications you take daily.
• Using pH monitoring to determine the severity of your condition. Doctors will sometimes place a special wireless device in your esophagus during an endoscopy that monitors the pH level to confirm your reflux. Another option they may use is a nasogastric tube with sensors that you go home with.
• Running tests to evaluate esophageal motility, which is how well the esophagus contracts.
• Undergoing an X-ray and upper endoscopy to view your anatomy. This test will allow your doctor to see how well your GE junction valve works.

Your doctor will take all results into consideration before recommending a TIF procedure.

The day before your appointment, you’ll likely need to stop eating or drinking about 12 hours before your procedure. This helps ensure your stomach is empty.

Your care team will also direct you on an individual basis about what medicines you should or should not take before your procedure.

Common post-operative symptom concerns include nausea and stomach pain or discomfort. Because vomiting could damage the operative site, you will likely take medication to try and reduce the likelihood of getting sick to your stomach.

Your doctor should help you identify symptoms that might be cause for concern, but it’s worth asking if they don’t go over it.

Some key tips for when you return home after surgery are:

• Avoid vomiting, coughing, or retching whenever possible. You may be prescribed anti-nausea medication to take regularly to help prevent this.
• Take small bites and chew thoroughly when eating solid foods.
• Avoid eating 2 hours before bedtime.
• Avoid using straws.
• Refrain from smoking.

A very important thing after any surgery is to give yourself time to rest. Depending on the demands of your job, you may need to take several days off to recover.

You should be able to resume light activity after about a week, and most people can return to all physical activities after about 7 weeks post-procedure.

Post-op diet for the TIF procedure

The diet your doctor recommends after a TIF procedure is meant to help the surgical site heal.

While your doctor may provide more specific instructions, UCLA Health offers a common post-op diet approach:

• First 2 weeks after surgery: Eat a full liquid diet, including gelatin, tea, juice, milkshakes, creamy soups, and popsicles.
• 3 weeks after surgery: Eat a purée diet, including foods you can put in a blender like puréed soups and meats.
• 4 weeks after surgery: Eat a soft food diet.
• 5 to 6 weeks after surgery: Eat a diet that’s slightly modified from your regular diet, being sure to avoid dried or hard foods.

After 6 weeks post-procedure, you can usually return to a regular diet with your doctor’s approval.

Doctors associate the TIF procedure with fewer complications than some surgical alternatives, such as the Nissen fundoplication.

An estimated 2.4 percent of patients reported severe adverse events after the TIF procedure. The most common procedure complications include:

• bleeding
• dysphagia (problems swallowing)
• perforation of the esophagus or stomach
• pleural effusion (when fluid builds up between your lungs and chest cavity)

Pneumothorax — perforation of the lung — is another potential complication. Research in 2019 found that 2 out of 51 cases (3.9 percent) of TIF procedures result in pneumothorax. Pneumothorax is highly treatable but would prolong recovery after surgery.

Another potential complication is that the TIF procedure may not effectively treat your GERD. Some people have reported that their symptoms returned 6 to 12 months after the procedure.

The TIF procedure is a noninvasive surgery that can help relieve acid reflux and conditions that cause irritation of the esophagus.

The procedure can be performed on an outpatient basis for some people, with just a brief observation period.

If you experience chronic GERD symptoms that do not resolve with medications or other at-home treatments, you may want to talk to a doctor about this option.