Categories
Procedure
What is the EsophyX Z+ device?
The EsophyX Z+ device helps physicians reconstruct the gastroesophageal valve and restore its function as a reflux barrier. The device is used during the TIF 2.0® procedure to create an approximate 3 cm, 270° esophagogastric fundoplication, depending on the patient’s anatomy.
Built for Precision and Control
- Compatible with a wide range of high-definition endoscopes
- Simultaneous dual-fastener deployment through an ergonomic trigger-handle design
- Tissue mold engineered to shroud stylets during fastener delivery
- Compatible with 7.5 mm SerosaFuse Implantable Fastener cartridges
Features and Benefits
Engineered for Reconstruction
- Helical Retractor
Engages and retracts tissue, anchoring the gastroesophageal junction throughout fundoplication. Stows and locks safely inside the tissue mold during insertion and removal. - Tissue Mold and Chassis
Plicates and compresses tissue, rotating the fundus around the esophagus to form the partial wrap. - Stylets and SerosaFuse Implantable Fasteners
Deliver durable tissue apposition, with fasteners maintaining tissue compression throughout the healing process. - Invaginator
Suctions esophageal tissue circumferentially, reduces small hiatal hernias (2 cm or less), and facilitates proper positioning of the fundoplication caudal to the diaphragm. - SerosaFuse and Implantable Fasteners
Provide web strength equivalent to a 3-0 suture while being designed to help avoid entrapment of blood vessels or nerves. The low-profile design minimizes foreign body presence, allowing the mucosa to remodel over the defect and helping protect the muscularis from the digestive environment. Fasteners are made of non-resorbable polypropylene.
FAQs
What is the EsophyX Z+ device and how is it used? 
The EsophyX Z+ device from Merit Medical is used to perform the TIF 2.0 procedure. Using an endoscopic approach, the device creates an approximately 3 cm, 270° esophagogastric fundoplication with SerosaFuse Implantable Fasteners.
For patients with hiatal hernias >2 cm, the TIF 2.0 procedure can be performed consecutively with a hiatal hernia repair during the same anesthesia session. This combined approach is known as cTIF.
What conditions is the EsophyX Z+ device indicated to treat?
The EsophyX Z+ Fastener Delivery Device with SerosaFuse Fastener and accessories is indicated for use in transoral tissue approximation, full thickness plication and ligation in the GI tract and is indicated for the treatment of symptomatic chronic gastroesophageal reflux disease in patients who require and respond to pharmacological therapy. It is also indicated to narrow the gastroesophageal junction and reduce hiatal hernia ≤ 2cm in size in patients with symptomatic chronic gastroesophageal reflux disease. Patients with hiatal hernias larger than 2cm may be included, when a laparoscopic hiatal hernia repair reduces the hernia to 2cm or less.
How does the EsophyX Z+ device reconstruct the gastroesophageal valve?
Inserted transorally, the device creates a full-thickness tissue fold at the gastroesophageal junction and secures it using SerosaFuse Implantable Fasteners to restore the natural anti-reflux barrier without external incisions.
What clinical evidence supports TIF 2.0 outcomes?
TIF 2.0 is supported by the TEMPO Trial,1 the AFS White Paper on TIF 2.0,2 and the ASGE 2024 practice guidelines for GERD.3 For additional clinical data, visit Our clinical data page.
May I request training on the EsophyX Z+ device?
Merit Medical is committed to supporting the development and implementation of your GERD program. Learn more about our TIF 2.0 training opportunities.
Who do I contact about reimbursement?
Please contact your Merit Medical representative for reimbursement information.
What if my question wasn’t answered here?
Please contact Merit Medical Customer Service for further assistance.
Documents
Clinical Research & Articles
• Outcomes of transoral incisionless fundoplication (TIF 2.0): a prospective multicenter cohort study in academic and community gastroenterology and surgery practices (with video)
• More articles here >
The Instructions for Use (IFU) provided on this page are for general information purposes only. Please refer to the IFU provided with the actual product for indications, contraindications, warnings, precautions, and directions for use.
Order Information
| CATALOG NUMBER | DESCRIPTION | FASTENER SIZE | FASTENER COUNT | DELIVERY SIZE |
| R2007 | EsophyX® Z+ Fastener Delivery Device | 60F | ||
| R2175 | SerosaFuse® Implantable Fastners | 7.5 mm | 20 | |
| R2275 | EsophyX® Z+ with SerosaFuse® Implantable Fasteners | 7.5 mm | 40 | 60F |
Training and Education
We offer clinical training opportunities designed to promote the safe and effective use of the EsophyX Z+ device during the TIF 2.0 procedure. Training runs on a monthly cadence.
Designed and taught by physicians, Merit Medical’s immersive education courses include didactic presentations, taped or live cases, and hands-on training.
Procedures and Resources
References
1. Trad et al. 2018. Surg Innov. doi: 10.1177/1553350618755214.
2. The American Foregut Society Clinical Practice Committee TIF Working Group et al. 2023. Foregut. doi: 10.1177/26345161231170788.
3. The ASGE Standards of Practice Committee et al. 2025. Gastrointest Endosc. doi: 10.1016/j.gie.2024.10.008.
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