Clinical Report: Transcriptomic Effects of Endoscopic Gastroplication in Upper GI Tract
Overview
Endoscopic gastroplication using the ACE stapler induces significant genome-wide transcriptomic changes in the stomach and duodenum one year post-procedure. These molecular alterations correlate with substantial weight loss and improvements in inflammatory and metabolic parameters in obese patients.
Background
Bariatric surgery is the most effective treatment for sustained weight loss in severe obesity, with traditional procedures like Roux-en-Y gastric bypass and sleeve gastrectomy widely used. Endoscopic gastroplication is a novel, minimally invasive technique that reduces stomach volume without tissue removal or intestinal bypass, performed transorally. While metabolic and anti-inflammatory effects of bariatric surgery have been studied, data on molecular changes in the upper gastrointestinal tract, especially after gastroplication, remain limited. This study investigates transcriptomic changes in the fundus, antrum, and duodenum one year after endoscopic gastroplication and their relation to clinical outcomes.
Data Highlights
Parameter
Baseline
1 Year Post-Gastroplication
Median Excess Weight Loss (%)
0
34.9 (IQR 17.8–46.6)
Biopsy Sites Analyzed
Fundus, Antrum, Duodenum
Fundus, Antrum, Duodenum
Number of Patients
10
10 (with 2 fundus/antrum samples excluded)
Gene Sets Significantly Enriched (FDR < 0.25)
Not applicable
Multiple pathways identified via GSEA
Plasma Adiponectin and Cytokine Levels
Measured
Measured and analyzed for changes
Key Findings
Endoscopic gastroplication resulted in a median 34.9% loss of excess weight at 1 year.
Transcriptomic analysis revealed significant gene expression changes in the fundus, antrum, and duodenum mucosa post-procedure.
Gene set enrichment analysis identified pathways related to metabolism and inflammation altered after gastroplication.
Plasma biomarkers including adiponectin and cytokines showed changes consistent with improved metabolic and inflammatory status.
The procedure was performed without skin incisions, using transoral access and vacuum-assisted full-thickness plications.
Only mild adverse effects were reported, indicating a favorable safety profile.
Clinical Implications
Endoscopic gastroplication offers a minimally invasive alternative for weight loss in obese patients, inducing beneficial molecular changes in the upper GI tract that may underlie improvements in metabolic and inflammatory parameters. Understanding these transcriptomic adaptations can help optimize patient selection and post-procedure management. The favorable safety and efficacy profile supports its consideration in clinical practice for appropriate candidates.
Conclusion
This study demonstrates that endoscopic gastroplication induces significant transcriptomic remodeling in the upper gastrointestinal mucosa, correlating with meaningful weight loss and improved inflammatory markers. These findings enhance understanding of the biological mechanisms underlying this novel bariatric intervention.
References
Paulus et al. 2017 -- First human ACE stapler study
MADMAX pipeline and GSEA methodology references
Laboratory of Translational Immunology, University Medical Center Utrecht -- Multiplex immunoassay methods
