Endoscopic foregut surgery and interventions: The future is now. The state-of-the-art and my personal journey

Figure 27 Endoscopic sleeve gastroplasty plus mucosal ablation and suturing of the esophageal gastric junction in a 45-year-old female with super morbid obesity, gastroparesis and gastroesophageal reflux disease. Her body mass index was 51 (327 lb) and she declined bariatric surgery. A: Markings created along anterior and posterior gastric wall to guide suture placement; B: First suture placed by taking bites at anterior, greater curve, posterior wall × 2; C: Total of 8 running sutures placed to complete the “sleeve”; D: At the very proximal aspect of the sleeve, a final suture is placed in a purse-string fashion around an 8 mm balloon to prevent complete closure; E: Endoscopic appearance within the completed sleeve; F: Endoscopic appearance of the proximal “pouch” which filled up with approximately 60 mL of water; G: Mucosal ablation and suturing of the esophageal gastric junction (MASE) procedure was performed as well, using 3 additional sutures, to treat her gastroesophageal reflux disease; H: UGI X-ray with contrast 1 d post endoscopic sleeve gastroplasty and MASE shows contrast filling the small gastric pouch with little to no passage through the sleeve at 1 h.