Post written by William King, MD, from the Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida, USA.

This patient had a history of lung transplant for pulmonary sarcoidosis and a Toupet fundoplication for severe GERD. His Toupet wrap became loose and slipped into a small hiatal hernia, resulting in severe reflux and recurrent episodes of aspiration pneumonia. Our video demonstrates use of transoral incisionless fundoplication (TIF) for rescue therapy.

GERD is common after lung transplant. It is simultaneously a cause of pulmonary fibrosis, an effect of lung transplant, and among the foremost threats to graft survival. Many patients were historically left with no options if surgical fundoplication failed or they were a poor surgical candidate.

First, TIF is not merely a primary therapy; this case demonstrates the technique for use as rescue therapy after a surgical fundoplication has loosened. Second, TIF is a viable alternative to surgical fundoplication in the lung transplant population and may reduce aspiration events.

To our knowledge, this is the first case of an ongoing single-center prospective study on use of TIF in lung transplant recipients.

The EsophyX device was then used to plicate a new gastroesophageal flap valve. This frame demonstrates placement of the first fastener.

Read the full article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.