Redo-Endoscopic Sleeve Gastroplasty for Obesity Treatment: a Multicenter Study on Feasibility, Safety, Efficacy, and Technical Predictors of Outcomes.

BACKGROUND: Endoscopic sleeve gastroplasty (ESG) is an effective bariatric procedure; however, a subset of patients experiences suboptimal weight loss or recurrent weight gain over time. Redo-ESG has emerged as a potential revisional approach aimed at restoring gastric restriction. OBJECTIVE: To assess the feasibility, safety, and efficacy of Redo-ESG and to identify clinical and technical variables associated with greater weight loss outcomes. METHODS: This multicenter, retrospective observational study included consecutive patients who underwent Redo-ESG at six tertiary bariatric endoscopy centers. Demographic, clinical, and procedural variables were collected, including indication for revision, baseline BMI, previous reduction grade, suture pattern and location, number of sutures and stitches, procedure duration, endoscope type, and operator experience. Univariate analyses were performed to identify predictors of success and were predefined as exploratory and hypothesis-generating. RESULTS: Twenty-five patients (84% female; mean age 48 ± 9 years; baseline BMI 34.4 ± 5.1 kg/m²) underwent Redo-ESG with 100% technical success. At a mean follow-up of 17 ± 12 months, additional %TWL was 10.8 ± 8.7%, and 52% of patients achieved clinically meaningful weight loss. Recurrent weight gain as the indication, higher baseline BMI, overlapping suture configuration, and single-channel endoscope use were identified as independent variables of greater weight loss. Two self-limited bleeding adverse events (8%) were observed, with no mortality or need for surgery. CONCLUSION: Redo-ESG appears a feasible, safe, and effective revisional endoscopic therapy in selected patients. Recurrent weight gain indication, higher baseline BMI, overlapping suture configuration, and single-channel endoscope use were associated with superior outcomes.