Practice patterns of transoral incisionless fundoplication: results of the TIF-US survey

Transoral incisionless fundoplication (TIF) is an FDA-approved endoscopic procedure for managing gastroesophageal reflux disease (GERD). Despite growing adoption and supporting evidence, significant variability exists in clinical practice. The study aimed to characterize current TIF practice patterns among U.S.-based gastroenterologists and surgeons.

A 33-question web-based survey was distributed to 305 U.S. physicians that perform TIF. The survey assessed endoscopist demographics, pre-procedure evaluation, procedural techniques, and post-procedure care. Responses were collected via REDCap and analyzed using descriptive statistics.

Sixty-eight physicians responded (22.3%) response rate, representing all U.S. regions. Most respondents were gastroenterologists (73.5%), with over half having completed interventional endoscopy training. Only 40.3% learned TIF during formal training. Preoperative pH testing was routinely performed by 90% of respondents when GERD diagnosis was not confirmed. The adoption of cruroplasty with TIF (cTIF) is common, with most participants (80.6%) performing both TIF and cTIF in their practice. Nearly half (48%) offered TIF to patients with BMI ≥ 35, despite this being a relative contraindication. Post-procedure, 91% discharged within 24 h. Post-operative opiate prescriptions are common, with 43% of physicians reporting they always prescribe a course of opiates for post-TIF pain. Most practitioners (60%) only perform post-TIF ambulatory pH studies or endoscopy on symptomatic patients.

This first nationwide survey highlights significant heterogeneity in TIF practice patterns, particularly in training, patient selection, and perioperative management. Our findings support the need for standardized training, society guidelines, and additional research to optimize safety and efficacy of TIF.