Safety and Efficacy of Transoral Incisionless Fundoplication for Post–Esophageal Peroral Endoscopic Myotomy Gastroesophageal Reflux Disease With Esophagitis: A Meta-Analysis

<h2>ABSTRACT</h2><h3>BACKGROUND AND AIMS</h3> Esophageal peroral endoscopic myotomy (E-POEM) is a gold-standard, minimally invasive treatment for achalasia and related esophageal motility disorders. However, gastroesophageal reflux disease (GERD) is a common complication after E-POEM, potentially compromising patient outcome. Transoral incisionless fundoplication (TIF) is an endoscopic technique designed to restore the competency of the gastroesophageal junction and reduce GERD symptoms. This meta-analysis evaluates the safety and efficacy of TIF in managing GERD with esophagitis following E-POEM. <h3>METHODS</h3> We performed a comprehensive, systematic search of multiple electronic databases, including conference proceedings, from inception through November 2024 to identify studies that evaluated the efficacy and safety of TIF in patients with GERD post E-POEM. Pooled proportions were calculated using both Mantel-Haenszel method (fixed effects model) and Der Simonian Laird method (random effects model). The heterogeneity among studies was tested using Cochran's Q test based on inverse variance weights. Primary outcomes were technical success, reduction in daily proton-pump inhibitor (PPI) and improvement in esophagitis. Secondary outcomes included procedure time, adverse event rates, and improvement in the GERD Health-Related Quality of Life (GERD-HRQL) Questionnaire. <h3>Results</h3> Seven studies comprising 212 patients with post-E-POEM GERD with esophagitis were included, with 59 undergoing TIF. Pooled mean interval between E-POEM and TIF was 16 months (95% CI, 8.00-24.00). Pooled technical success was 100% (95% CI, 91.07-100). GERD Health-Related Quality of Life scores improved from 39.82 ± 11.18 to 14.61 ± 4.6 post-TIF. The pooled odds ratio for esophagitis post-TIF vs pre-TIF was 0.28 (95% CI, 0.10-0.79). Proton pump inhibitor discontinuation was achieved in 69.45% (95% CI, 55.44-81.83). Mean procedure time was 60.17 minutes, and the adverse event rate was 13.87%, with all events being mild, self-limited, and no mortality was reported. <h3>CONCLUSION</h3> TIF is a safe and effective treatment for GERD with esophagitis following E-POEM, improving symptoms and reducing proton pump inhibitor dependence. Additional studies are needed to confirm long-term benefits.