P1367 - Practice Patterns of Practitioners That Perform Transoral Incisionless Fundoplication: Results of a Nationwide Survey of TIF-Trained Physicians

Brennan Gioe, MD¹, Fouad Jaber, MD¹, Mohammed Ayyad, MD², Wasif Abidi, MD, PhD¹, Fares Ayoub, MD¹, Kalpesh Patel, MD¹, Olaya Brewer Gutierrez, MD³, Brett Parker, MD³, Roy Tomas Davee, MD⁴, Erik Wilson, MD⁴, Nirav Thosani, MD⁴, Wasseem Skef, MD⁴
1Baylor College of Medicine, Houston, TX; 2Rutgers New Jersey Medical School, Newark, NJ; 3Johns Hopkins University School of Medicine, Baltimore, MD; 4University of Texas Health, McGovern Medical School, Houston, TX

Introduction: Transoral incisionless fundoplication (TIF) with or without cruroplasty is a minimally invasive endoscopic anti-reflux procedure that is safe and effective for the management of chronic symptomatic gastroesophageal reflux disease (GERD). Although >25,000 TIF procedures have been performed worldwide, there remains significant variation in practice patterns amongst those performing TIF. In our study, we surveyed TIF practitioners in the United States to describe clinical practice variation amongst surgeons and gastroenterologists in different settings to identify trends and inform areas for future research.

Methods: We conducted a cross-sectional study of TIF providers in the United States through a web-based survey using RedCap software. The questionnaire comprised of 35 questions divided into four sections (respondent demographics; pre-procedure evaluation and criteria for TIF; periprocedural management and technical aspects of procedure performance; long term follow-up of TIF patients). A secure survey was sent to TIF trained gastroenterologists and surgeons identified using an online directory (GERDHelp.com). Study dates were from Jan-Feb 2025. 

Results: 67 TIF-trained physicians completed the survey (20% response rate). 58 respondents (87%) were gastroenterologists, with 33 (57%) reporting completing an advanced endoscopy fellowship. Less than half of participants (40.3%) learned TIF during their post-graduate training. Refractory GERD was the most common indication for TIF (61%). Almost half (49%) of respondents offer the procedure for patients with a body mass index > 35. During the TIF procedure, most endoscopists typically place 20-24 fasteners (74.6%). Almost half of respondents (45%) use an endoscopy technician or nurse as the assistant endoscopist during the procedure. Post procedure 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.

Discussion: In our survey, we observed significant heterogeneity in practice patterns amongst TIF practitioners in the United States. Further investigation, training standardization and evidence-based practice guidelines are warranted in order to inform best practices.


Figure: Survey results related to respondent demographics and pre-procedural evaluation of TIF


Figure: Survey results related to technical aspects of TIF procedure and follow up of TIF patients

Disclosures:
Brennan Gioe indicated no relevant financial relationships.
Fouad Jaber indicated no relevant financial relationships.
Mohammed Ayyad indicated no relevant financial relationships.
Wasif Abidi indicated no relevant financial relationships.
Fares Ayoub indicated no relevant financial relationships.
Kalpesh Patel indicated no relevant financial relationships.
Olaya Brewer Gutierrez indicated no relevant financial relationships.
Brett Parker indicated no relevant financial relationships.
Roy Tomas Davee indicated no relevant financial relationships.
Erik Wilson indicated no relevant financial relationships.
Nirav Thosani: Alpfa medical – Consultant. Roseaid – Creatorship rights.
Wasseem Skef indicated no relevant financial relationships.

Brennan Gioe, MD¹, Fouad Jaber, MD¹, Mohammed Ayyad, MD², Wasif Abidi, MD, PhD¹, Fares Ayoub, MD¹, Kalpesh Patel, MD¹, Olaya Brewer Gutierrez, MD³, Brett Parker, MD³, Roy Tomas Davee, MD⁴, Erik Wilson, MD⁴, Nirav Thosani, MD⁴, Wasseem Skef, MD⁴. P1367 - Practice Patterns of Practitioners That Perform Transoral Incisionless Fundoplication: Results of a Nationwide Survey of TIF-Trained Physicians, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.