Transoral Incisionless Fundoplication (TIF) Registry Study for Treatment of Gastroesophageal Reflux Disease (GERD)

Primary Effectiveness Endpoint: Typical and atypical GERD symptom elimination (scores ≤ 2 to
each question) or clinically significant improvement (≥ 50% reduction in total scores) at
6-month follow-up compared to baseline.

Secondary Effectiveness Endpoints: GERD symptom elimination or clinically significant
improvement at 12-month follow-up, 24-month follow-up and 36-month follow-up; complete
discontinuation of PPIs; normalization of esophageal acid exposure; significant reduction in
reflux episodes; healing of reflux esophagitis; reduction of hiatal hernia; safety supported
by low incidence of serious adverse events.

Inclusion Criteria:

- Age 18-75 years

- GERD for > 1 year

- History of daily PPIs use for > 6 months

- Moderate to severe typical or atypical GERD symptoms off PPIs

- Complete (responders) or partial (nonresponders) symptom control on PPIs

- Deteriorated gastroesophageal junction (Hill grade II or III)

- Proven gastroesophageal reflux by either endoscopy, ambulatory pH or barium swallow
testing

- Willingness to undergo pH/impedance testing, if required

- Willingness to cooperate with the postoperative diet for 6 weeks

- Availability for follow up visits at 6 months and 12 months

- Willingly and cognitively signed informed consent

Exclusion Criteria:

- BMI > 35

- Incompletely reducible hiatal hernia with residual of > 5 mm

- Esophagitis grade D

- Barrett's Esophagus > 2 cm

- Esophageal ulcer

- Fixed esophageal stricture or narrowing

- Portal hypertension and/or varices

- Active gastro-duodenal ulcer disease

- Gastric outlet obstruction or stenosis

- Gastroparesis or delayed gastric emptying confirmed by solid-phase gastric emptying
study, if patient complains of postprandial satiety during assessment

- Coagulation disorder

- History of any of the following: resective gastric or esophageal surgery, antireflux
surgery with anatomy unsuitable for TIF procedure per physician judgment, cervical
spine fusion, Zenker's diverticulum, esophageal epiphrenic diverticulum, achalasia,
scleroderma or dermatomyositis, eosinophilic esophagitis, or cirrhosis

- Pregnancy or plans of pregnancy in the next 12 months

- Enrollment in another device or drug study that may confound the results