UCSF bariatric surgeons Matthew Y.C. Lin, M.D. and Stanley J. Rogers, M.D. are helping to pioneer a novel incisionless endoscopic approach called endoluminal suturing for patients who either gained or failed to lose sufficient weight following bariatric surgery, a phenomenon know as WR/IWL that occurs in 1 in 5 or 20% of patients. Over time, the initial gastric bypass anatomy may enlarge or dilate allowing food to empty faster, greatly reducing the efficacy of the initial surgery. Standard therapy has been to re-operate laparoscopically to restore the initial restrictive anatomy, but often times these surgeries must be converted to an open procedure, one that carries significant risk for the patient. Principal investigators in the UCSF Bariatric Surgery Program are now testing a novel and innovative approach that allows restoration of the restrictive anatomy necessary to reverse WR/IWL without a surgical incision. Initial clinical trials showed high patient satisfaction, with favorable preliminary safety and efficacy outcomes. The ongoing clinical study and related efforts of UCSF bariatric surgeons were highlighted in the December 2013 issue of San Francisco Medicine, Journal of the San Francisco Medical Society.