Efficacy and Safety of a Revised Gastric Peroral Endoscopic Myo‐Neurotomy Procedure for Bariatric Endoscopy in a Porcine Model

ABSTRACT Background Endoscopic sleeve gastroplasty is a minimally invasive and effective treatment for obesity, although gastric mucosa folding and subsequent reduced visibility of the gastric lining raise concerns for some patients. This study evaluates the safety and efficacy of a revised peroral endoscopic myo‐neurotomy (R‐POEM‐N) technique using a submucosal approach as an alternative bariatric procedure in a porcine model. Methods Twelve pigs underwent either an R‐POEM‐N procedure ( n = 8) or a sham endoscopic procedure ( n = 4). Myo‐neurotomy was performed at four sites in the R‐POEM‐N group: two on the greater curvature of the gastric body and two in the antrum. All pigs were fed diets at twice the standard weight‐equivalent dose and observed for 8 weeks (8 W) following the procedure. The primary outcome was the proportional change in body weight at 8 W, calculated as the ratio of weight change to baseline weight. Secondary outcomes included changes in serum glucolipid levels, food intake, and the safety and duration of R‐POEM‐N. Results R‐POEM‐N was successfully completed in all pigs without significant adverse events. The procedure time was 171.3 ± 3.0 min. The proportional change in body weight was significantly lower in the R‐POEM‐N group compared with the control group ( p = 0.017). Food intake in the R‐POEM‐N group was significantly lower than that in the control group ( p < 0.05). Changes in serum glycolipid levels were not significantly different between groups. Conclusions R‐POEM‐N successfully reduced weight gain in pigs, supporting its potential as a novel bariatric intervention with minimal invasiveness.