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Background <p>Transoral incisionless fundoplication (TIF) is relatively contraindicated in patients with a body mass index (BMI) &gt; 35&#xa0;kg/m<sup>2</sup>. However, the comparative efficacy of TIF in individuals with class I obesity (BMI 30–34.9) to non-obese patients remains unclear. This study aimed to evaluate the safety and efficacy of TIF in adults with class I obesity.</p> Methods <p>We conducted a retrospective cohort study using the TriNetX US Research Network, including data from 69 healthcare organizations through December 2024. Adults (≥ 18&#xa0;years) with gastroesophageal reflux disease (GERD) who underwent TIF were identified using validated International Classification of Diseases, 10<sup>th</sup> Revision (ICD-10) and Current Procedural Terminology (CPT) codes. Patients were stratified by BMI (&lt; 30 versus 30–35). Exclusion criteria in this study included the following: individuals with a BMI &gt; 35, major esophageal motility disorders, or concomitant hiatal hernia repair. We performed propensity score matching (1:1) and controlled for age, sex, race, ethnicity, diaphragmatic hernia, and proton pump inhibitor (PPI) use. Primary outcomes included postoperative PPI recidivism (excluding the first 3&#xa0;months), post-TIF esophagitis, and need for subsequent foregut surgery. Secondary outcomes included post-TIF dysphagia, gas bloat symptoms, and 30-day complications.</p> Results <p>After propensity matching, 112 non-obese and 112 class I obese patients were included with similar baseline characteristics. Median follow-up exceeded 1,000&#xa0;days in both groups. Postoperative PPI recidivism, esophagitis, surgical interventions, dysphagia and complications were similar. Notably, bloating was significantly lower in the obese group at 1&#xa0;year (aOR 0.420; 95% CI 0.18–0.95) and maximum follow-up (aOR 0.446; 95% CI 0.21–0.97).</p> Conclusions <p>TIF appears safe and effective for GERD in adults with class I obesity with comparable outcomes to non-obese patients.</p>

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Efficacy and safety of transoral incisionless fundoplication in non-obese and obese adults: a population-based cohort study from the United States

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月2日

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  • Fouad Jaber,
  • Saltenat Moghaddam Adames,
  • Mohamed Jaber,
  • Kinan Obiedat,
  • Kalpesh Patel,
  • Teminioluwa A. Ajayi,
  • Roy Tomas DaVee,
  • Fares W. Ayoub,
  • Nirav Thosani,
  • Wasseem Skef

摘要

Background

Transoral incisionless fundoplication (TIF) is relatively contraindicated in patients with a body mass index (BMI) > 35 kg/m2. However, the comparative efficacy of TIF in individuals with class I obesity (BMI 30–34.9) to non-obese patients remains unclear. This study aimed to evaluate the safety and efficacy of TIF in adults with class I obesity.

Methods

We conducted a retrospective cohort study using the TriNetX US Research Network, including data from 69 healthcare organizations through December 2024. Adults (≥ 18 years) with gastroesophageal reflux disease (GERD) who underwent TIF were identified using validated International Classification of Diseases, 10th Revision (ICD-10) and Current Procedural Terminology (CPT) codes. Patients were stratified by BMI (< 30 versus 30–35). Exclusion criteria in this study included the following: individuals with a BMI > 35, major esophageal motility disorders, or concomitant hiatal hernia repair. We performed propensity score matching (1:1) and controlled for age, sex, race, ethnicity, diaphragmatic hernia, and proton pump inhibitor (PPI) use. Primary outcomes included postoperative PPI recidivism (excluding the first 3 months), post-TIF esophagitis, and need for subsequent foregut surgery. Secondary outcomes included post-TIF dysphagia, gas bloat symptoms, and 30-day complications.

Results

After propensity matching, 112 non-obese and 112 class I obese patients were included with similar baseline characteristics. Median follow-up exceeded 1,000 days in both groups. Postoperative PPI recidivism, esophagitis, surgical interventions, dysphagia and complications were similar. Notably, bloating was significantly lower in the obese group at 1 year (aOR 0.420; 95% CI 0.18–0.95) and maximum follow-up (aOR 0.446; 95% CI 0.21–0.97).

Conclusions

TIF appears safe and effective for GERD in adults with class I obesity with comparable outcomes to non-obese patients.