First Report of Successful Endoscopic Full-Thickness Plication Using the GERDx System to Treat Refractory GERD After...

Gastroesophageal reflux disease (GERD) frequently develops or worsens after sleeve gastrectomy (SG), and symptoms may persist despite optimal proton pump inhibitor (PPI) therapy due to postsurgical anatomical changes. Endoscopic full-thickness plication (eFTP) is a minimally invasive approach used to reinforce the gastroesophageal junction barrier. However, its feasibility after SG remains unclear given restricted retroflexion and reduced gastric compliance. This case represents the first reported use, to our knowledge, of GERDx eFTP in a post-SG patient with refractory GERD. The patient, a 40-year-old woman, had experienced severe GERD symptoms for 6 years after her SG and failed maximal PPI therapy. Evaluation revealed a 2-cm sliding hiatal hernia and pathological acid exposure. She underwent eFTP without any complications and had complete symptom resolution by 1 week, with successful discontinuation of PPIs at 3 months. This case demonstrates the technical feasibility of GERDx eFTP in a carefully selected post-SG patient with refractory GERD.