S2161 Practice Patterns of Practitioners That Perform Transoral Incisionless Fundoplication: Results of a Nationwide Survey of TIF-Trained Physicians

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 4 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 January-February 2025. Results: Sixty-seven 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. Conclusion: 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.