Endoscopic Gastric Mega-plication (MEGA) for the Primary Treatment of Obesity: "A European Multicenter Retrospective...

Obesity is a chronic and highly prevalent disease. Although bariatric surgery is the most effective treatment, access remains limited. Endoscopic bariatric therapies have emerged as minimally invasive alternatives. MEGA (Endoscopic Gastric Megaplication) is a modified version of POSE 2.0 that uses two G-LIX devices, a 33-mm G-PROX, and fewer sutures (mean: six) to create double gastric plications, with the goal of streamlining the procedure.

To evaluate the technical reproducibility, clinical efficacy, and safety of the MEGA technique at 6 months in a multicenter cohort of patients with obesity, and to explore inter-center variability and correlations between technical and clinical outcomes.

This retrospective multicenter cohort study included 54 patients with BMI (kg/m²) ≥ 27and comorbidities or BMI ≥ 30, treated with MEGA across six European centers experienced in bariatric endoscopy. Procedures were performed by local endoscopists after standardized training by a single instructor. Technical variables (number of sutures, procedure time) and clinical outcomes (%TBWL, %EBWL) were analyzed.

At 6 months, mean %TBWL was 14.75 ± 6.24% (95% CI:13.05-16.45), and mean %EBWL was 56.17 ± 33.75% (95% CI: 46.96-65.39), with no significant differences among centers (p = 0.406). Overall, 81.5% of patients (95% CI: 69.2-89.6) achieved ≥ 10% TBWL. No serious adverse events were reported. No correlation was found between number of sutures and %TBWL.

In this preliminary multicenter study with 6-month follow-up, the MEGA technique was associated with clinically meaningful weight loss and no serious adverse events. Larger prospective studies with long-term follow-up are needed.