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= Transoral incisionless fundoplication - TIF procedure = Transoral incisionless fundoplication, also known TIF procedure, is an endoscope treatment that can relieve symptoms of gastroesophageal reflux disease (GERD). The TIF procedure, similar to Nissen fundoplication, alleviates GERD symptoms by performing a partial wrap of the stomach around the esophagus. g

TIF, unlike Nissen fundoplication, does not require surgical incisions. Instead a surgical device (called the EsophyX) is inserted into the mouth, passed through the throat, and into the stomach. An endoscope is utilized to perform the procedure in order to avoid the need for incisions.

The procedure is performed while the patient is under general anesthesia and is typically an outpatient procedure.

Other medical treatments to alleviate GERD symptoms include:
 * Stretta procedure
 * Proton-pump Inhibitors

History
The device utilized to perform the procedure, called EsophyX, was developed by EndoGastric Solutions. The first TIF procedure utilizing the device was performed in 2005. In 2007, EsophyX, was approved for use in medical procedures by the United States Food and Drug Administration.

As of 2016, more than 17,000 TIF procedures had been performed.

In July 2016, Health Care Service Corporation (HCSC) became the first United States health insurance company to add the TIF procedure to their medical coverage policy. HSCS added the TIF procedure to their health insurance policy at the recommendation of both the American Gastroenterological Association (AGA) and The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES).

Evidence
In 2012, the TIF EsophyX vs Medical PPI Open Label (TEMPO) trial was conducted to compare the efficiency of the TIF procedure to PPI therapy in the treatment of GERD symptoms. At the six month follow up, 62% of the TIF patients and 5% of the PPI patients experienced the elimination of all GERD (other than heartburn) symptoms. Despite the results of the study, the need for followup studies was suggested.

In 2014, a report about a double blind study was published. The study was conducted to determine the TIF procedure's ability to eliminate GERD symptoms. Patients were randomly split into two groups. One group received the TIF procedure and a placebo. The other half a sham surgery and omeprazole. After six months, 67% reported the elimination of troublesome regurgitation (a GERD symptom) versus 45% in the sham group. The study also found that TIF provided better control of hearburn after six months. Medium heartburn scores of TIF patients decreased from 2.6 to 0.5.

In 2014, a longer study was concluded that assessed the long-term affects of the TIF procedure on patients with GERD symptoms. 50 patients were followed up with up to six years after the procedure was conducted. The study found that after three years around 75-80% of the patients ceased to need or halved the amount of PPI therapy due to decreased GERD symptoms.