Transoral incisionless fundoplication as rescue therapy for gastroesophageal reflux in a lung transplant recipient
William King, MD,
Hannah Zuercher, MD,
Manuel Amaris, MD,
Amir Emtiazjoo, MD,
Mindaugas Rackauskas, MD, PhD,
Bashar Qumseya, MD, MPH
Affiliations
William King, MD
Division of Gastroenterology, Hepatology, and Nutrition, University of Florida College of Medicine, Gainesville, Florida, USA; Corresponding author: Dr William King, Division of Gastroenterology, Hepatology, and Nutrition, University of Florida College of Medicine, PO Box 100214, Gainesville, Florida 32610, USA.
Hannah Zuercher, MD
Division of Internal Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
Manuel Amaris, MD
Division of Gastroenterology, Hepatology, and Nutrition, University of Florida College of Medicine, Gainesville, Florida, USA
Amir Emtiazjoo, MD
Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
Mindaugas Rackauskas, MD, PhD
Division of Thoracic Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
Bashar Qumseya, MD, MPH
Division of Gastroenterology, Hepatology, and Nutrition, University of Florida College of Medicine, Gainesville, Florida, USA
Background and Aims: A patient with a prior lung transplant and surgical fundoplication had severe recurrent gastroesophageal reflux disease (GERD) and chronic retrograde microaspiration, which both threatened his graft function and elevated his risk for retransplant. He was deemed a poor candidate for surgical fundoplication. We therefore aimed to perform a transoral incisionless fundoplication (TIF). Methods: The gastroesophageal flap valve was loose on diagnostic esophagogastroduodenoscopy. We used a plication device to repair the existing fundoplication, forming a 270°, 3-cm wrap using 12 H-type fasteners. Results: Erosive esophagitis improved from Los Angeles grade C to A and acid exposure time from 30% to 5%. Heartburn symptoms resolved. He underwent repeat lung transplant. Conclusions: The video in this case demonstrates the technique for TIF after surgical fundoplication. This case also supports the use of TIF as rescue therapy for post-lung transplant GERD.
