Transoral Incisionless Fundoplication in Laryngopharyngeal Reflux Disease: a Systematic Review and Meta-Analysis
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Published on: September 22, 2023
Jérôme R Lechien1, Antonino Maniaci2
1Department of Surgery, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium; Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, Paris Saclay University, Paris, France; Department of Otolaryngology-Head and Neck Surgery, Elsan Hospital, Paris, France; Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre, Brussels, Belgium.
Objectives:
To investigate the effectiveness of transoral incisionless fundoplication (TIF) on laryngopharyngeal reflux symptoms.
Review Method:
A PRISMA systematic review was conducted through PubMed, Scopus, and the Cochrane Library databases for studies reporting laryngopharyngeal symptom or sign outcomes following TIF in adult patients with suspected or confirmed LPRD. The risk of bias was assessed using the Clarity Group tool and MINORS. Observational cohorts of TIF were pooled using random-effects models in jamovi. Reflux symptom index (RSI) and Gastroesophageal reflux disease-health-related quality of life (GERD-HRQL) were analyzed as pre-post mean differences, and cure rate as a proportion.
Results:
Fifteen studies (8 prospective, 7 retrospective) accounting for 917 patients were included (525 females, 372 males; mean age 39.0-66.0 years). RSI and GERD-HRQL were used across all studies. Preoperative RSI ranged from 14.0 to 29.0 and decreased to 4.0-12.9 postoperatively, while GERD-HRQL decreased from 15.3-38.6 to 2.0-14.8. No study established the LPRD diagnosis with pharyngeal ambulatory pH study or assessed laryngopharyngeal signs. TIF significantly improved RSI (mean difference = 13.69 points, 95% CI 11.34-16.05) and GERD-HRQL (19.70, 16.05-23.35; both P < 0.0001; k = 11). Pooled cure rate was 0.82 (0.78-0.86; prediction interval 0.71-0.93). Heterogeneity was high for symptom scores, unexplained by study design or methodological quality (mean MINORS of 9.9). No study confirmed the LPRD diagnosis with ambulatory pharyngeal pH study.
Conclusion:
TIF appears effective in improving reflux-related symptoms, but confirmed LPRD diagnosis and objective outcomes are lacking. Future studies are needed in specific LPRD populations.
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