Video Tip: TIF: Preparing to Recreate the Flap Valve | May 2022-TIF Preparing to Recreate the Flap Valve

Video Transcription

So the, the TIF device is already in place it's the Asophix Z plus, and the endoscope is inside the device so the endoscope is coming out through the side port.  So it's placed endoscopically I just did that a few minutes ago, and then the scope comes out to the side port so now you're looking at the G junction and a retroflex view.  And you can see here, what we're looking at here are the sling fibers, and this is the anterior sling fiber and if we go the other way that's the posterior side.  So the goal is to recreate a flat valve, the G flat valve, which will be three centimeters in length, at least 270 degrees wrap and Mimi has shown in the TIF registry that it's key  to get beyond 270 degree. And she showed in the TIF registry presented last year at DDW that you can get normalization  of acid exposure to 84% if you do greater than 270 degrees with the TIF alone. So the length is important, but also the degree of wrap is important.  So you're creating a true flat valve, not just the tightening not just the gastric glycation, but recreating the physiologic flat valve.  So Ken, there was a lot of discussion earlier about, you know, where you want to place the sutures and the pledges and stuff, so, you know, do you, is there a difference on the  lesser versus the greater? It sounds like you go all around or more than 270 degree around?  Yeah. So the key is the flat valve is this part, which is on the greater curve and the natural  occurring flat valve with these sling fibers will want to close from greater curve towards that lesser curve, which is on the other side at 12 o'clock.  So it's like a door that opens and closes. It swings from greater curve to lesser curve. The lesser curve is the backstop.  So with that in mind, you don't want to mess with the lesser curve because that's the receiving end.  You want to tighten the sling fibers by making it tight around the circumference of the G junction, tucked into the posterior corner, tucked into the anterior corner.  And then on the greater curve, you want to lengthen. So it's not just a random tightening. You want to create an omega valve that's open towards the lesser curve because you want  the valve to shut towards the lesser curve. And because the corer is working in the exact same direction as the flat valve.  So you want the corer and the flat valve to work in synergy, not opposing.

Video Summary

In this video, the speaker discusses the TIF device, specifically the Asophix Z plus, and how it is used endoscopically to recreate a flat valve at the G junction. The goal is to achieve at least a three-centimeter length and a wrap of at least 270 degrees, as research has shown that going beyond 270 degrees can lead to normalization of acid exposure. The speaker emphasizes the importance of creating a true flat valve by properly placing sutures and pledges. They explain that the natural flat valve closes from the greater curve towards the lesser curve, and it is important to tighten the sling fibers while lengthening on the greater curve to ensure the valve functions correctly. The speaker also highlights the need for the corer and the flat valve to work in synergy. No credits were given in the transcript.

Keywords

TIF device

Asophix Z plus

endoscopic procedure

flat valve

G junction