Introduction: Obesity is a chronic, highly prevalent disease. Although bariatric surgery is the most effective treatment, access remains limited to a small proportion of eligible patients. Endoscopic bariatric techniques have emerged as minimally invasive alternatives. MEGA (Endoscopic Gastric Megaplication) is a variant of POSE 2.0 that employs two G-LIX, a 33 mm G-PROX, and a reduced suture pattern (average: six) to achieve double gastric plication, aiming to improve procedural efficiency and sustainability.

Primary objective: To evaluate the technical reproducibility, clinical efficacy, and safety of the MEGA technique at 6 months in a multicenter cohort of patients with obesity.

Secondary objectives: To analyze inter-center variability in weight loss outcomes and explore correlations between technical and clinical variables.

Retrospective cohort study including 54 patients with BMI >27 and comorbidities or BMI >30, treated with MEGA at six European centers experienced in bariatric endoscopy. Procedures were performed by local endoscopists after standardized training delivered by a single instructor. Technical (number of sutures, procedure time) and clinical variables (%TBWL, %EBWL) were collected. Comparative and correlational analyses were performed.

At 6 months, mean %TBWL was 14.75 ± 6.24 % and mean %EBWL was 56.17 ± 14.91 %, with no significant differences among centers (p = 0.406). A total of 81.48 % of patients achieved>10 % TBWL (44/54). No adverse events were reported. The mean number of sutures was 6.36 ± 0.76, and the mean procedure time was 31,4 ± 11.30 minutes. No significant correlation was found between number of sutures and %TBWL (rho = 0.20; p = 0.747). A moderate, negative Pearson correlation was observed between baseline BMI and %EBWL (r = -0.542), indicating that patients with a higher baseline BMI tended to exhibit a lower percentage of excess body weight loss, likely due to greater baseline excess weight.

MEGA proved to be an effective, safe, and reproducible endoscopic technique. Its consistent outcomes across centers support its implementation as a sustainable option for the endoscopic management of obesity. Further prospective studies with larger sample sizes are warranted to confirm these findings.