Endoscopic gastric body plication for the treatment of obesity: technical success and safety of a novel technique (with video)

Background and Aims: Primary obesity surgery endoluminal (POSE) is a primary endoscopic bariatric therapy focusing on gastric remodeling. The original POSE procedure involved placement of full-thickness plications in the fundus. Here we aim to assess the feasibility, safety, and efficacy of a novel POSE procedure that involves plications of only the gastric body to reduce the width and length of the stomach. Methods: This was a pilot study of patients who underwent a distal POSE procedure with gastric body plications for the treatment of obesity. Outcomes included technical success rate, serious adverse event (AE) rate, and efficacy of this novel POSE procedure at inducing weight loss and improving obesity-related comorbidities. Results: Ten patients (6 women, age 52 +/- 20 years) underwent a distal POSE procedure. Baseline body mass index was 38.1 +/- 6.2 kg/m(2). The technical success rate was 100%. An average of 21 +/- 4 plications were placed per case (6 +/- 2 for distal belt, 10 +/- 3 for suspenders, 4 +/- 2 for proximal belt, and 3 +/- 1 for fillers). The gastro-esophageal junction was pulled distally by 3.0 +/- 1.6 cm. The gastric body was shortened by 11.0 +/- 5.1 cm, representing a 59% reduction. The serious AE rate was 0%. At 6 months, patients experienced 15.0% +/- 7.1% total weight loss (TWL). All patients achieved at least 5% TWL, and 8 patients (80%) achieved at least 25% excess weight loss. Hypertension, diabetes, GERD, and obstructive sleep apnea improved after the procedure. Conclusions: This novel POSE procedure, focusing on gastric body plication and sparing the fundus, is technically feasible and appears to be safe and effective for the treatment of obesity.