***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background EsophyX is an endolumenal approach to the treatment of  gastroesophageal reflux disease ( GERD ) . This report describes one of the earliest and largest North American experiences with this device . Methods Prospect i ve data were gathered on consecutive patients undergoing EsophyX fundoplication for a 1-year period between September 2007 and March 2009 . During this time , the procedure evolved to the current technique . A P value less than 0.05 was considered significant . Results The study enrolled 26 patients with a mean age of 45 years . The patients included 16 women ( 62 % ) with a mean body mass index ( BMI ) of 28 and an American Society Anesthesiology ( ASA ) classification of 2 . These patients included 11 with associated small hiatal hernias , 3 with Barrett ’s esophagus , and 5 with esophageal dysmotility . The procedure time was 65 min ( range , 29–137 min ) , and the length of hospital stay was 1 day ( range , 0–6 days ) . The postoperative valve circumference was 217º , and the valve length was 2.7 cm . Two complications of postoperative bleed occurred , requiring transfusion . The mean follow-up period was 10 months . Comparison of pre- and postoperative Anvari scores ( 34–17 ; P = 0.002 ) and Velanovich scores ( 22–10 ; P = 0.0007 ) showed significant decreases . Although 68 % of the patients were still taking antireflux medications , 21 % had reduced their dose by half . Three patients had persistent symptoms requiring Nissen fundoplication , and there was one late death unrelated to the procedure . Conclusion This study represents an initial single-institution experience with EsophyX. According to the findings , 53 % of the patients had either discontinued their antireflux medication ( 32 % ) or had decreased their dose by half ( 21 % ) . Both symptoms and health-related quality -of-life ( HRQL ) scores significantly improved after treatment . Further follow-up evaluation and objective testing are required Background A novel transoral incisionless fundoplication ( TIF ) procedure using the EsophyX system with SerosaFuse fasteners was design ed to reconstruct a full-thickness valve at the gastroesophageal junction through tailored delivery of multiple fasteners during a single-device insertion . The safety and efficacy of TIF for treating gastroesophageal reflux disease ( GERD ) were evaluated in a prospect i ve multicenter trial . Methods Patients ( n = 86 ) with chronic GERD treated with proton pump inhibitors ( PPIs ) were enrolled . Exclusion criteria included an irreducible hiatal hernia > 2 cm . Results The TIF procedure ( n = 84 ) reduced all hiatal hernias ( n = 49 ) and constructed valves measuring 4 cm ( 2–6 cm ) and 230 ° ( 160 ° –300 ° ) . Serious adverse events consisted of two esophageal perforations upon device insertion and one case of postoperative intraluminal bleeding . Other adverse events were mild and transient . At 12 months , aggregate ( n = 79 ) and stratified Hill grade I tight ( n = 21 ) results showed 73 % and 86 % of patients with ≥50 % improvement in GERD health-related quality of life ( HRQL ) scores , 85 % discontinuation of daily PPI use , and 81 % complete cessation of PPIs ; 37 % and 48 % normalization of esophageal acid exposure ; 60 % and 89 % hiatal hernia reduction ; and 62 % and 80 % esophagitis reduction , respectively . More than 50 % of patients with Hill grade I tight valves had a normalized cardia circumference . Resting pressure of the lower esophageal sphincter ( LES ) was improved significantly ( p < 0.001 ) , by 53 % . EsophyX-TIF cured GERD in 56 % of patients based on their symptom reduction and PPI discontinuation . Conclusion The 12-month results showed that EsophyX-TIF was safe and effective in improving quality of life and for reducing symptoms , PPI use , hiatal hernia , and esophagitis , as well as increasing the LES resting pressure and normalizing esophageal pH and cardia circumference in chronic GERD patients Background . Incomplete control of troublesome regurgitation and extraesophageal manifestations of chronic gastroesophageal reflux disease ( GERD ) is a known limitation of proton pump inhibitor ( PPI ) therapy . This multicenter r and omized study compared the efficacy of transoral incisionless fundoplication ( TIF ) against PPIs in controlling these symptoms in patients with small hiatal hernias . Methods . Between June and August 2012 , 63 patients were r and omized at 7 US community hospitals . Patients in the PPI group were placed on maximum st and ard dose ( MSD ) . Patients in the TIF group underwent esophagogastric fundoplication using the EsophyX2 device . Primary outcome was elimination of daily troublesome regurgitation or extraesophageal symptoms . Secondary outcomes were normalization of esophageal acid exposure ( EAE ) , PPI usage and healing of esophagitis . Results . Of 63 r and omized patients ( 40 TIF and 23 PPI ) , 3 were lost to follow-up leaving 39 TIF and 21 PPI patients for analysis . At 6-month follow-up , troublesome regurgitation was eliminated in 97 % of TIF patients versus 50 % of PPI patients , relative risk ( RR ) = 1.9 , 95 % confidence interval ( CI ) = 1.2 - 3.11 ( P = .006 ) . Globally , 62 % of TIF patients experienced elimination of regurgitation and extraesophageal symptoms versus 5 % of PPI patients , RR = 12.9 , 95 % CI = 1.9 - 88.9 ( P = .009 ) . EAE was normalized in 54 % of TIF patients ( off PPIs ) versus 52 % of PPI patients ( on MSD ) , RR = 1.0 , 95 % CI = 0.6 - 1.7 ( P = .914 ) . Ninety percent of TIF patients were off PPIs . Conclusion . At 6-month follow-up , TIF was more effective than MSD PPI therapy in eliminating troublesome regurgitation and extraesophageal symptoms of GERD Background A new endoluminal fundoplication ( ELF ) technique performed transorally using the EsophyX ™ device was evaluated for the treatment of gastroesophageal reflux disease ( GERD ) in a prospect i ve , feasibility clinical trial . Methods Nineteen patients were enrolled into the study . Inclusion criteria were chronic and symptomatic GERD , proton pump inhibitor ( PPI ) dependence , and the absence of esophageal motility disorder . Two patients were excluded due to esophageal stricture and a 6 cm hiatal hernia . The median duration of GERD symptoms and PPI use in the remaining 17 patients was 10 and 6 years , respectively . The ELF procedure was design ed to partially reconstruct the antireflux barrier through the creation of a valve at the gastroesophageal junction . Results The ELF-created valves had a median length of 4 cm ( range 3–5 cm ) and circumference of 210 ° ( 180–270 ° ) . Adherence of the valves to the endoscope was tight ( n = 14 ) or moderate ( n = 3 ) . Hiatal hernias present in 13 patients ( 76 % ) were all reduced . Adverse events were limited to mild or moderate pharyngeal irritation and epigastric pain , which resolved spontaneously . After 12 months , the ELF valves ( n = 16 ) had a median length of 3 cm ( 1–4 cm ) and a circumference of 200 ° ( 150–210 ° ) . Eighty-one percent of valves retained their tightness . The hiatal hernias present at the baseline remained reduced in 62 % of patients . The median GERD-HRQL scores improved by 67 % ( 17–6 ) , and nine patients ( 53 % ) improved their scores by ≥50 % . Eighty-two percent of patients were satisfied with the outcome of the procedure , 82 % remained completely off PPIs , and 63 % had normal pH. Conclusion The study demonstrated technical feasibility and safety of the ELF procedure using the EsophyX ™ device . The study also demonstrated maintenance of the anatomical integrity of the ELF valves for 12 months and provided preliminary data on ELF efficacy in reducing the symptoms and medication use associated with GERD BACKGROUND Antireflux therapy may lead to recovery of impaired mucosal integrity in gastro-esophageal reflux disease ( GERD ) patients as reflected by an increase in baseline impedance . The study objective was to evaluate the effect of endoscopic fundoplication and proton pump inhibitor ( PPI ) PPI therapy on baseline impedance and heartburn severity in GERD patients . METHODS Forty-seven GERD patients r and omized to endoscopic fundoplication ( n = 32 ) or PPI therapy ( n = 15 ) , and 29 healthy controls were included . Before r and omization and 6 months after treatment , baseline impedance was obtained during 24-h pH-impedance monitoring . Heartburn severity was evaluated using the  GERD-HRQL question naire . KEY RESULTS Before treatment , baseline impedance in GERD patients was lower than in healthy controls ( p < 0.001 ) . Antireflux therapy  increased baseline impedance ( from 1498 [ IQR 951 - 2472 ] to 2393 [ IQR 1353 - 3027 ] Ω , p = 0.001 ) , however it only led to a partial recovery when compared to healthy controls ( 2393 [ IQR 1353 - 3027 ] vs 2983 [ 2335 - 3810 ] Ω , p < 0.01 ) . The effect of both treatment options was not significantly different ( p = 0.13 ) despite the increased number of non-acid reflux events in the PPI group . No correlation was found between baseline impedance and GERD symptoms before or after treatment . CONCLUSIONS & INFERENCES Reduction in acid reflux by endoscopic fundoplication or PPI therapy leads to an increase in baseline impedance in GERD patients , likely to reflect recovery of mucosal integrity . The impact of non-acid reflux events on esophageal mucosal integrity may be limited as no difference in the increase in baseline impedance was observed after both treatment options . The lack of association between impedance baseline and heartburn severity indicates that other factors may contribute to heartburn perception in GERD Introduction Transoral incisionless fundoplication ( TIF ) with the EsophyX ™ device is reported to be effective for creating a continent gastroesophageal valve and for good functional results , as measured by pH impedance in patients with gastroesophageal reflux disease ( GERD ) . The aim of this study is to assess the long-term effect of TIF in patients with symptomatic GERD . Patients and methods  TIF 2.0 fundoplication was done in 42 consecutive patients . All were studied with GERD-HRQL and GERD-QUAL question naires , upper gastrointestinal ( GI ) endoscopy , esophageal manometry , and 24 h pH impedance  before and at 6 , 12 , and 24 months after TIF . Results In all , 35 patients completed 6-month follow-up ; 21 ( 60.0 % ) completely stopped proton pump inhibitor ( PPI ) therapy , 6 ( 17.1 % ) more than halved it , and 8 ( 22.9 % ) continued with the same dose as before the procedure . There were 26 patients with complete 24-month follow-up ; 11 ( 42.3 % ) completely stopped PPI therapy , 7 ( 26.9 % ) more than halved it , and 8 ( 30.8 % ) were taking the same dose as before the procedure . Hiatal hernia and ineffective esophageal motility seemed to raise the risk of recurrence of symptoms ( p = 0.02 and p < 0.001 , respectively ) . The number of fasteners deployed during TIF was the only factor predictive of successful outcome ( p = 0.018 ) . Conclusions TIF using the EsophyX device allowed withdrawal or reduction of PPI in about 77 % of patients at 6-month follow-up and about 69 % at 24 months . Larger number of fasteners deployed during TIF was predictive of positive outcome ; pre-TIF ineffective esophageal motility and hiatal hernia raised the risk of recurrence of GERD symptoms , but were not significant from a prospect i ve point of view Background The aim of this r and omized , crossover study was to determine if transoral fundoplication ( TF ) could further improve clinical outcomes in partial responders to high-dose ( HD ) proton-pump inhibitor ( PPI ) therapy and to evaluate durability of TF . Methods In seven United States centers , patients with hiatal hernia ≤2 cm and abnormal esophageal acid exposure ( EAE ) were r and omized to TF ( n = 40 ) or HD PPIs ( n = 23 ) group . At 6-month follow-up , PPI patients underwent crossover 
    Output:
    
The total number of refluxes was reduced after TIF compared with the PPIs/sham group .
The esophageal acid exposure time and acid reflux episodes after TIF were not significantly improved .
Proton-pump inhibitors ( PPIs ) usage increased with time and most of the patients resumed PPIs treatment at reduced dosage during the long-term follow-up .
Conclusions TIF is an alternative intervention in controlling GERD-related symptoms with comparable short-term patient satisfaction .
Long-term results showed decreased efficacy with time .
Patients often resume PPIs at reduced doses in the near future