Post written by Reem Z. Sharaiha, MD, from the Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital and Weill Cornell Medical Center, New York, New York.

In this video we present a 63-year-old woman with class II obesity (BMI 36 kg/m 2 ), 236 lbs, proton-pump inhibitor (PPI)-responsive GERD, who was referred for further management of her obesity and GERD. She required double dose PPI for her reflux symptoms, and despite some weight loss was unable to control symptoms with a daily PPI.

After reviewing the risks, benefits, and alternatives, the decision was made to pursue an endoscopic sleeve gastroplasty (ESG) and transoral incisionless fundoplication (TIF) in the same session. We performed the TIF first using the EsophyX Z+ device (Endogastric Solutions Redmond, WA), creating a 270-degree wrap. Next, the ESG was performed using the Apollo OverStitch device (Apollo Endosurgery, Austin, TX) resulting in a tubular configuration of the stomach, with a markedly reduced gastric body volume. The total procedure time was 67 minutes (24 minutes TIF; 44 minutes ESG). The patient was discharged home post-endoscopy without any adverse events. She was maintained on a full-liquid diet for the first 3 weeks. On follow-up 2 months post-procedure, she reported a 43-pound weight loss (18% TBWL) and 3 inches off of her waist line, with no reflux symptoms on a daily PPI.

It is important to show that we as endoscopists can treat 2 of the growing problems in the U.S. (GERD and Obesity) with endoscopy.  In this case we demonstrate that it can be done in the same session. Endoscopic therapies have emerged to serve an unmet need in obesity and GERD therapy and are safe and efficacious tools when used in conjunction with dietary and lifestyle changes. As techniques and devices mature, it is paramount that gastroenterologists appropriately select patients for these procedures with a multidisciplinary team. Same session ESG and TIF has not previously been reported; here, we demonstrate its safety and viability as a tailored approach in the treatment of concomitant obesity and GERD.

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