Endoscopic full-thickness plication
rotatory
FIRE

EFTP was performed using the GERDX system by a single endoscopist (A.M.) in patients allocated to the endoscopic plication group. After careful examination of the esophagus and stomach, a guidewire with a long flexible tip (G-SURG GmbH) was placed into the stomach antrum using a gastroscope (GIF-HQ190; Olympus, Tokyo, Japan). The device was prepared by attaching the disposable staple on one arm and the receiving pledget on the opposite instrument arm. The arms of the device were then closed, and then the loaded instrument (distal end lubricated) was introduced over the guidewire into the stomach. Air was then insufflated into the stomach using the attached inflating cuff. An ultrathin gastroscope (GIF-XP190N; Olympus) was then passed through the channel of the EFTP device and retroflexed to view the GEJ (S.V.). The device arms were then opened and positioned using rotatory as well as to and fro movements. A screw-tipped tissue retractor (helix) was then pushed forward through the center of the open arms and to at least 1 cm below the Z line in the gastric mucosa along the greater curvature. Once in the correct position, the tissue helix was rotated clockwise to enter the stomach wall. The tissue retractor was then withdrawn to pull the tissue between the open arms of the EFTP device. The device arms were then closed to fire the staples through the pulled stomach wall (

 Endoscopic full-thickness plication (EFTP) procedure.
