MASE for Severe GERD After Sleeve Gastrectomy: AES | September 2026

Conventional Approach:

GERD after laparoscopic sleeve gastrectomy (LSG) can be difficult to manage because the fundus has been resected, gastric geometry is altered, and intragastric pressure may increase. PPIs remain first-line therapy, while severe refractory reflux may require surgical conversion, commonly to Roux-en-Y gastric bypass.

Why was a new technique needed?

Conventional fundoplication is difficult after sleeve gastrectomy because of the absence of an intact fundus.

Some patients have persistent reflux despite optimized medical therapy.

Revisional bariatric surgery is effective but considerably more invasive.

This creates a potential therapeutic space for anatomy-adapted endoscopic anti-reflux procedures.

New Technique: MASE

MASE (Mucosal Ablation and Suturing of the Esophagogastric Junction) combines targeted mucosal ablation at the gastric cardia with full-thickness endoscopic suturing. Cinching the treated tissue promotes remodeling and creates a tighter, reinforced gastroesophageal junction. Importantly, the procedure can be performed through an antegrade, forward-viewing approach and does not require an intact gastric fundus.

Clinical Utility:

MASE may offer a minimally invasive option for selected patients with refractory GERD after sleeve gastrectomy.

Its main advantage is applicability in altered post-surgical anatomy where fundoplication-based techniques may not be feasible.

Other emerging approaches include ARMA/ARMS and endoscopic suturing techniques.

Patient selection should consider anatomy, reflux mechanism, physiology, hiatal anatomy, and previous bariatric surgery.

Evidence remains limited, and long-term comparative efficacy and durability require further study.

Take-home Message:

Post-sleeve GERD may require an anatomy-specific rather than one-size-fits-all approach. MASE offers a promising endoscopic option for selected patients with altered anatomy, but its precise role relative to medical therapy and revisional surgery remains to be established.