Figure 2.

Endoscopic sleeve gastroplasty. A, We perform a U-shaped suture pattern. B, We approach the target site from a distance. We start at the anterior wall and anchor the tissue using a tissue helix. We do not exert excess pressure on the helix and rotate it only 3 times to prevent deeper penetration and damage to abdominal organs. C, We continue to traverse through the greater curve and the posterior wall, and then repeat the pattern in reverse before cinching. We ensure the suture runs in 1 direction without forming alpha loops. D, Successful creation of a full-thickness plication at the distal body. We repeat this and progress proximally to complete the sleeve gastroplasty. We spare the fundus of the stomach.