Endoscopic Gastric Mucosal Resection Targeting Gastric Volume Reduction Attenuates Body Weight gain and Suppresses Fasting Ghrelin in a Porcine Model

Abstract Background Based on the principle of fibrotic remodeling and stricture formation post-resection, we developed a novel endoscopic bariatric procedure, endoscopic gastric mucosal resection (EGMR), that targets the gastric body and fundus with the aim of reducing gastric volume and suppressing ghrelin levels. The aim of this study was to investigate the feasibility, efficacy, and safety of EGMR in the porcine model. Methods Ten healthy Yorkshire pigs were randomly assigned to the experimental group ( n = 5) and the control group ( n = 5). The experimental group underwent endoscopic mucosal resection and endoscopic submucosal dissection targeting approximately 50% of the gastric body and fundus mucosa. Weight was recorded at weekly intervals over a 12-week observation period. Fasting ghrelin levels were assessed at baseline and at 4 and 8 weeks post-EGMR. Structural changes were assessed radiographically, with the findings corroborated by endoscopic evaluation and necropsy. Results EGMR was successfully performed in all pigs in the experimental group. Both groups gained weight throughout the 12-week study period; however, from 7 weeks post-EGMR onward, body weight was significantly lower in the experimental group compared with the control group ( p < 0.05). Likewise, mean fasting ghrelin levels decreased significantly at 4 and 8 weeks compared to the control group ( p = 0.001 and p < 0.001, respectively). Gastroscopy confirmed complete ulcer healing at 8 weeks post-EGMR. Necropsy findings corroborated the structural changes observed on radiographic imaging. One intraprocedural perforation (20%) was successfully managed endoscopically using endoclips. Conclusion In this pilot study, EGMR was technically feasible and attenuated expected weight gain in healthy juvenile pigs, rather than inducing weight loss in animals with obesity. Structural remodeling suggestive of reduced gastric volume and suppression of ghrelin provided evidence of a likely combination of mechanical and hormonal effects. All complications were managed endoscopically, but the observed perforation underscores the need for refinement before human studies.