Endoscopic Sleeve Gastroplasty Combined With GERDx Endoscopic Full-Thickness Plication for Obesity-Associated Mechanical GERD: A Dual-Mechanism Endoscopic Case Series

Obesity-associated gastroesophageal reflux disease (GERD) is often driven by mechanical factors including increased intra-abdominal pressure, hiatal hernia, and gastroesophageal junction dysfunction. Endoscopic sleeve gastroplasty (ESG) reduces gastric volume and intragastric pressure, whereas endoscopic full-thickness plication (eFTP) reinforces the antireflux barrier. However, data on the intentional combination of these interventions remain limited. This retrospective case series included 9 patients with overweight or obesity and proton pump inhibitor-refractory GERD who underwent same-session ESG and GERDx eFTP at a tertiary endoscopy center. eFTP was performed first, followed by ESG during the same session. All procedures were completed successfully without adverse events. Follow-up (1 month–2 years) demonstrated weight loss, improvement in reflux symptoms, and reduced proton pump inhibitor use. Repeat physiologic testing in selected patients showed improvement in DeMeester scores and esophageal acid exposure. Combined ESG and GERDx eFTP may represent a minimally invasive strategy addressing both intragastric pressure and gastroesophageal junction dysfunction in obesity-associated GERD.