Post written by Ravishankar Asokkumar, MBBS, MRCP, and Gontrand Lopez-Nava, MD, PhD, from the Bariatric Endoscopy Unit, HM Sanchinarro University Hospital, Madrid, Spain, and the Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore.

We described a novel primary endoscopic approach to treat obesity using the incision-less operating platform (USGI Medical, USA). We have shared information on the device, the endoscopy unit set-up, the suturing technique, and tips for performing a successful gastroplasty.

There is a gross mismatch between the number of patients living with obesity and those who seek treatment. The available evidence indicates that it would take approximately 43 years to operate on the current eligible obese patients, not including the new extra patients added each year by the expanding epidemic. Thus, new, effective, least-invasive, and patient-preferred treatment options are required to address obesity.

Recently, endoscopic options, including endoscopic sleeve gastroplasty and intragastric balloons, are gaining acceptance as treatment alternatives for obesity because of their effectiveness and low adverse event rates. However, more therapeutic options are required to target different pathways of obesity and have a durable treatment effect. Also, the availability of multiple treatment options allows us to customize treatment based on patient preference.

Primary obesity surgery endoluminal (POSE-2) procedure narrows and shortens the gastric lumen using a series of full-thickness plications placed in the body of the stomach. Unlike its predecessor technique, which targeted the gastric fundal accommodation, the POSE-2 procedure attempts to impair the gastric motility and restrict the gastric volume. Our video demonstrates the suture pattern and the plication technique employed to reduce the gastric volume. We believe POSE-2 can be an additional endoscopic treatment option for obesity.

In our series treating 22 patients, we observed a total body weight loss of 15.7% at 6-months and demonstrated a delay in gastric emptying in 68% of patients. The patients achieved satiation quickly, with a one-third reduction in their meal intake. The patients were discharged within 24 hours, and no adverse events occurred after the procedure.

The results from our experience show POSE-2 procedure is safe and effective and can be performed as a short-stay procedure. POSE-2 can be learned efficiently with supervised training, and with the accumulation of more evidence, we hope the technique could be scaled as an additional management option for obesity.

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