Endoscopic Conversion of Sleeve Gastrectomy to Single Anastomosis Sleeve-ileal Bypass (SASI) for Gastroesophageal Reflux (GERD), Primary and Secondary Non-responder.

Inclusion criteria

• Subject must meet all the inclusion criteria to participate in this study and list each criterion.
• Age: 21-65 years
• Patients going for LSG at participating hospitals.
• Able to provide informed consent
• Individuals below age 21 would not be recruited as this is a study in the adult population. Individuals above age 65 are excluded to minimize the procedure risk.

Exclusion criteria

• Patients who were breast feeding or pregnant
• Severe psychiatric illness
• Eating disorder
• Active neoplastic disease
• End-stage renal disease
• Patients with bleeding diathesis
• Patients with pacemakers or implantable cardiac defibrillators
• Significant cardiovascular disease (e.g., acute myocardial infarction, congestive cardiac failure, ischemic heart disease, atrial fibrillation, sick sinus syndrome, supraventricular tachycardia)
• Any factors likely to limit adherence to study protocol (e.g., dementia; alcohol or substance abuse; history of unreliability in medication taking or appointment keeping; significant concerns about participation in the study from spouse, significant other or family members)
• Treatment with anti-platelet agents that could not be temporarily discontinued