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

## TL;DR

This study explores a new endoscopic procedure combining TIF and ESG to treat obesity-related GERD, showing promising results in weight loss and symptom improvement.

## Contribution

The study introduces a novel combined endoscopic technique (F-ESG) for treating GERD and obesity simultaneously.

## Key findings

- Participants achieved 13.1% weight loss at 6 months and 15.2% at 12 months.
- GERD Health-Related Quality of Life scores improved significantly from baseline to 12 months.
- All participants discontinued PPI therapy, and 7 out of 8 achieved normalized DeMeester scores by 12 months.

## Abstract

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.

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.

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.

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.

The online version contains supplementary material available at 10.1007/s11695-026-08526-3.