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              8210 154th NE
              Redmond, WA 98052
              Tel: 425.307.9200 Fax: 425.307.9201

              555 Twin Dolphin Drive, Ste. 620
              Redwood City, CA 94065
              Tel: 650.610.9250    Fax: 650.610.9251
              www.endogastricsolutions.com

              ©2008, EndoGastric Solutions. All rights reserved.
              EndoGastric Solutions, EsophyX and TIF are registered trademarks of
              EndoGastric Solutions, Inc.



C01735 01 A
EsophyX® TIF®
Patient
Instructions
EsophyX TIF Food Guid

                           POST-PROCEDURE WEEK                       1
                                      Broth of any kind
                 Strained soups (not tomato based)
  Nutritional supplements and vitamins (not ber)
                                                Pudding
                                                      Milk
                                                  Gelatin
                                                  Yogurt
                                        Cottage cheese
                  Well-cooked & pureed vegetables
                                 Moist & boneless sh
                        Canned fruits (without skins)
                                                Bananas
                                                  Melons
                                                  Berries
                                                     Tofu
                                   Meatless casseroles
                                               Soft eggs
                                    Cooked vegetables
                                      Mashed potatoes
                                     Pasta and noodles
                                Soft & moist white rice
                            Cereals (softened in milk)
                          Fresh vegetables and fruit*
                                                   Meats
                                                    Bread
                                                    Citrus
                                                 Alcohol



*Excluding asparagus, celery, pineapple and other long bered items
de                                            EndoGastric Solutions




                 YES       NO


2    3   4   5   6     7    8   9   10   11     12
EsophyX TIF Post-Procedure
Food Guide
EsophyX TIF
        This brochure is intended to give you a general overview of
        the EsophyX TIF procedure instructions. ALWAYS follow
        your doctor’s pre-procedure and post-procedure instructions.




      Pre-Procedure
      Instructions
        Make sure you inform your doctor about
        all the medications you are currently
        taking.

        Do not take any aspirin, blood thinners,
        anti-in ammatory (arthritis) medications,
        or vitamin E prior to your procedure.

        Do not take any diet aids, medications and
        herbal supplements containing gingko,
        garlic, or St. John’s Wort for 10 days prior to
        surgery.

        You should not smoke or drink alcohol for
        48 hours prior to your procedure.

        Your doctor will give you additional
        instruction depending on medications you
        are currently taking.

        It is critical that you do not eat or drink
        anything for at least 12 hours before your
        procedure or as indicated by your doctor.
        The EsophyX TIF procedure cannot be
        performed if there is food in your stomach.
        You may still take medication your doctor
        has approved for you to take with a small
        amount of water.


1
What about after
the procedure?
You will spend the night after the procedure in
the hospital. You will experience some pain and/or
discomfort in your chest for the rst few days after the
procedure. You may also have some irritation in your
nose, a sore throat and/or some discomfort swallowing
for a few days. These symptoms will resolve within the
 rst week after surgery and appropriate medication
will be provided to you if needed. If they do not
resolve, or if discomfort or other symptoms become
more severe, please notify your doctor immediately.
Continue to take your GERD medication for one week
after your procedure or as recommended by your
doctor.
Remember, occasional re ux is normal in healthy
people and may depend on diet and other factors
such as stress. If GERD symptoms reoccur you should
contact your doctor.



                                                          2
Post-Procedure
    Instructions
    Even though EsophyX TIF is an incisionless procedure,
    it is still surgery, and like any surgical procedure, the
    success of your EsophyX TIF procedure is greatly
    determined by how well you adhere to post-procedure
    instructions including:


       Dietary guidelines
       Physical activity
       Medications
       Return to work
       Follow-up




3
If you are experiencing any of the following
symptoms within 12 weeks following your
procedure, call your doctor immediately:



Any nausea or vomiting
Fever greater than 101° F
Increased abdominal pain
Di culty or pain while swallowing
Sore throat lasting more than seven days
after the procedure
Chest pain
Shoulder pain lasting more than 3-7 days




                                               4
Dietary
    Guidelines:
    The strength of your new antire ux valve is largely
    determined by how well it heals. What you eat and
    drink can dramatically impact the durability of your
    antire ux valve. You will be asked to follow a liquid
    diet followed by a mashed and soft food diet as your
    antire ux valve heals.
    If you experience heartburn after eating a particular
    food, write down the food that gave you heartburn
    and try to avoid eating it. Talk to your doctor at your
    next visit about your food-associated symptoms.
    Remember, occasional heartburn episodes are
    commonly experienced by people who do not su er
    from GERD, and this may in fact mean that your valve
    is functioning correctly. If your symptoms persist,
    contact your doctor immediately.




5
During the 12-week post-procedure period,
it is important that you adhere to the
following guidelines:



Eat 4 to 5 small meals consisting of soft foods
throughout the day
Take small bites and chew your food thoroughly
Avoid foods with course texture, nuts, raw fruits, and
raw vegetables
Avoid foods or drinks that in the past caused re ux
Remain in an upright position for 1 hour after eating
Do not eat for at least 2 hours before bedtime
Do not drink carbonated beverages or alcohol
Avoid spicy foods
Avoid foods and drinks that are very hot or very cold
Take anti-gas medication - do not belch
Try not to vomit, cough, retch or strain - this can
signi cantly a ect the healing and ultimately the
e ectiveness of the antire ux valve created during
your procedure
Do not smoke
You should also avoid gas-forming, acid-producing
foods, or foods that slow gastric emptying such as
tomato-based products, peppermint, black pepper,
ca eine-containing drinks, alcohol, onions, green
peppers, fatty foods, beans, spicy foods, citrus fruits,
and ber supplements


                                                           6
Physical Activity
    Walking is permitted and encouraged after your
    procedure. Begin to walk short distances, at a slow
    pace, and with someone who can assist you in case you
    experience any residual weakness due to anesthesia.
    Gradually increase the distance and duration of your
    walks until you feel you are back to normal. At this
    time, you may also climb stairs, although you should
    do it slowly for the rst few weeks to reduce the risk of
    increasing abdominal pressure.
    In order to give your valve time to heal and fuse, lifting
    anything over 5 pounds should absolutely be avoided
    for the rst 2 weeks. During Weeks 3-6, you may lift
    items up to 25 pounds, and beginning in Week 7 you
    may lift items as you normally would.
    Except for walking, sports and other intense exercises
    should be avoided for the rst 6 weeks following your
    procedure. At that time, you may consult with your
    doctor, who can help you determine if you are ready to
    resume your normal exercise routine.
    Driving may be resumed 1-2 days after the procedure.
    You should not drive if you are taking prescription
    pain medication, are experiencing fatigue, or are in
    signi cant pain.
    Sex may be resumed after 7 days.




7
Medications
Stay on your acid-reducing medications for the
 rst week following your procedure.
Before leaving the hospital, your physician may
prescribe pain medications. It is important that you
take this medication as prescribed. If you feel you
need to increase the strength or duration of your
prescription, please contact your physician.




Follow Up
After the procedure, your doctor will see you
again to assess the e ectiveness of the EsophyX
TIF procedure. Your doctor may also schedule
additional follow-up appointments at this time.




                                                       8
Return to Work
    Most patients will be able to return to work 3-7 days
    after the procedure. You and your doctor should
    determine a timetable for returning to work based
    on a number of factors including residual fatigue
    from general anesthesia, any complication during
    the procedure, your overall medical condition, and
    your psychological recovery time. If you work in a job
    that requires signi cant physical activity, you should
    not resume your normal job functions until after your
    doctor has cleared you to do so.




9

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Patient info for Esophyx

  • 1. R 8210 154th NE Redmond, WA 98052 Tel: 425.307.9200 Fax: 425.307.9201 555 Twin Dolphin Drive, Ste. 620 Redwood City, CA 94065 Tel: 650.610.9250 Fax: 650.610.9251 www.endogastricsolutions.com ©2008, EndoGastric Solutions. All rights reserved. EndoGastric Solutions, EsophyX and TIF are registered trademarks of EndoGastric Solutions, Inc. C01735 01 A
  • 3. EsophyX TIF Food Guid POST-PROCEDURE WEEK 1 Broth of any kind Strained soups (not tomato based) Nutritional supplements and vitamins (not ber) Pudding Milk Gelatin Yogurt Cottage cheese Well-cooked & pureed vegetables Moist & boneless sh Canned fruits (without skins) Bananas Melons Berries Tofu Meatless casseroles Soft eggs Cooked vegetables Mashed potatoes Pasta and noodles Soft & moist white rice Cereals (softened in milk) Fresh vegetables and fruit* Meats Bread Citrus Alcohol *Excluding asparagus, celery, pineapple and other long bered items
  • 4. de EndoGastric Solutions YES NO 2 3 4 5 6 7 8 9 10 11 12
  • 6. EsophyX TIF This brochure is intended to give you a general overview of the EsophyX TIF procedure instructions. ALWAYS follow your doctor’s pre-procedure and post-procedure instructions. Pre-Procedure Instructions Make sure you inform your doctor about all the medications you are currently taking. Do not take any aspirin, blood thinners, anti-in ammatory (arthritis) medications, or vitamin E prior to your procedure. Do not take any diet aids, medications and herbal supplements containing gingko, garlic, or St. John’s Wort for 10 days prior to surgery. You should not smoke or drink alcohol for 48 hours prior to your procedure. Your doctor will give you additional instruction depending on medications you are currently taking. It is critical that you do not eat or drink anything for at least 12 hours before your procedure or as indicated by your doctor. The EsophyX TIF procedure cannot be performed if there is food in your stomach. You may still take medication your doctor has approved for you to take with a small amount of water. 1
  • 7. What about after the procedure? You will spend the night after the procedure in the hospital. You will experience some pain and/or discomfort in your chest for the rst few days after the procedure. You may also have some irritation in your nose, a sore throat and/or some discomfort swallowing for a few days. These symptoms will resolve within the rst week after surgery and appropriate medication will be provided to you if needed. If they do not resolve, or if discomfort or other symptoms become more severe, please notify your doctor immediately. Continue to take your GERD medication for one week after your procedure or as recommended by your doctor. Remember, occasional re ux is normal in healthy people and may depend on diet and other factors such as stress. If GERD symptoms reoccur you should contact your doctor. 2
  • 8. Post-Procedure Instructions Even though EsophyX TIF is an incisionless procedure, it is still surgery, and like any surgical procedure, the success of your EsophyX TIF procedure is greatly determined by how well you adhere to post-procedure instructions including: Dietary guidelines Physical activity Medications Return to work Follow-up 3
  • 9. If you are experiencing any of the following symptoms within 12 weeks following your procedure, call your doctor immediately: Any nausea or vomiting Fever greater than 101° F Increased abdominal pain Di culty or pain while swallowing Sore throat lasting more than seven days after the procedure Chest pain Shoulder pain lasting more than 3-7 days 4
  • 10. Dietary Guidelines: The strength of your new antire ux valve is largely determined by how well it heals. What you eat and drink can dramatically impact the durability of your antire ux valve. You will be asked to follow a liquid diet followed by a mashed and soft food diet as your antire ux valve heals. If you experience heartburn after eating a particular food, write down the food that gave you heartburn and try to avoid eating it. Talk to your doctor at your next visit about your food-associated symptoms. Remember, occasional heartburn episodes are commonly experienced by people who do not su er from GERD, and this may in fact mean that your valve is functioning correctly. If your symptoms persist, contact your doctor immediately. 5
  • 11. During the 12-week post-procedure period, it is important that you adhere to the following guidelines: Eat 4 to 5 small meals consisting of soft foods throughout the day Take small bites and chew your food thoroughly Avoid foods with course texture, nuts, raw fruits, and raw vegetables Avoid foods or drinks that in the past caused re ux Remain in an upright position for 1 hour after eating Do not eat for at least 2 hours before bedtime Do not drink carbonated beverages or alcohol Avoid spicy foods Avoid foods and drinks that are very hot or very cold Take anti-gas medication - do not belch Try not to vomit, cough, retch or strain - this can signi cantly a ect the healing and ultimately the e ectiveness of the antire ux valve created during your procedure Do not smoke You should also avoid gas-forming, acid-producing foods, or foods that slow gastric emptying such as tomato-based products, peppermint, black pepper, ca eine-containing drinks, alcohol, onions, green peppers, fatty foods, beans, spicy foods, citrus fruits, and ber supplements 6
  • 12. Physical Activity Walking is permitted and encouraged after your procedure. Begin to walk short distances, at a slow pace, and with someone who can assist you in case you experience any residual weakness due to anesthesia. Gradually increase the distance and duration of your walks until you feel you are back to normal. At this time, you may also climb stairs, although you should do it slowly for the rst few weeks to reduce the risk of increasing abdominal pressure. In order to give your valve time to heal and fuse, lifting anything over 5 pounds should absolutely be avoided for the rst 2 weeks. During Weeks 3-6, you may lift items up to 25 pounds, and beginning in Week 7 you may lift items as you normally would. Except for walking, sports and other intense exercises should be avoided for the rst 6 weeks following your procedure. At that time, you may consult with your doctor, who can help you determine if you are ready to resume your normal exercise routine. Driving may be resumed 1-2 days after the procedure. You should not drive if you are taking prescription pain medication, are experiencing fatigue, or are in signi cant pain. Sex may be resumed after 7 days. 7
  • 13. Medications Stay on your acid-reducing medications for the rst week following your procedure. Before leaving the hospital, your physician may prescribe pain medications. It is important that you take this medication as prescribed. If you feel you need to increase the strength or duration of your prescription, please contact your physician. Follow Up After the procedure, your doctor will see you again to assess the e ectiveness of the EsophyX TIF procedure. Your doctor may also schedule additional follow-up appointments at this time. 8
  • 14. Return to Work Most patients will be able to return to work 3-7 days after the procedure. You and your doctor should determine a timetable for returning to work based on a number of factors including residual fatigue from general anesthesia, any complication during the procedure, your overall medical condition, and your psychological recovery time. If you work in a job that requires signi cant physical activity, you should not resume your normal job functions until after your doctor has cleared you to do so. 9