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Combining Transoral Incisionless Fundoplication and Endoscopic Sleeve Gastroplasty (F-ESG): An Endoscopic Approach to Treat Pathologic Gastroesophageal Reflux in Obesity

Year: 2026

Type: article

Abstract: BACKGROUND AND AIMS: Obesity-related Gastroesophageal Reflux Disease (GERD) presents a significant clinical challenge, limited by the effectiveness of current treatments. Excess weight impairs the repair of the anti-reflux barrier, and conventional obesity treatments may adversely affect anti-reflux physiology. This study systematically evaluates a modular endoscopic technique that combines Transoral Incisionless Fundoplication (TIF) with Endoscopic Sleeve Gastroplasty (ESG) simultaneously (F-ESG), offering a synergistic solution to both GERD and obesity. METHODS: This single-center pilot study enrolled adults with objectively confirmed pathologic GERD and incomplete symptomatic response to proton pump inhibitor therapy. Participants underwent the combined F-ESG procedure with standardized dietary and behavioral counseling. Outcomes were assessed at baseline, 6 months, and 12 months, including percent total weight loss (%TWL), GERD Health-Related Quality of Life (HRQL), Reflux Symptom Index (RSI), and DeMeester score (DMS) obtained from 48-hour pH monitoring. RESULTS: Eight participants (mean age 39 ± 6.4 years; 75% female; mean BMI 34.5 ± 3.7 kg/m²) were included. Mean %TWL was 13.1% at 6 months and 15.2% at 12 months. GERD HRQL improved from 26.4 at baseline to 8.3 at 6 months and 8.5 at 12 months (p < 0.01). RSI and DMS also demonstrated significant reductions. By 12 months, all participants had discontinued PPI therapy, and 7 of 8 achieved a normalized DeMeester score. CONCLUSIONS: In this single-center pilot study, same-session F-ESG was feasible and safe, with improvements in subjective and objective GERD metrics and weight loss through 12 months. Larger multicenter comparative studies are warranted to evaluate efficacy and durability.

Source: Obesity Surgery

DOI: 10.1007/s11695-026-08526-3

Authors: Maryam Alkhatry, Jamil Samaan, Barham Abu Dayyeh

Institutions: Ministry of Health, Cedars-Sinai Medical Center

Language: English

Topic: Gastroesophageal reflux and treatments

Subfield: Gastroenterology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $4,590