ROSE (Restorative Obesity Surgery, Endoluminal)

An endoscopic weight loss procedure is a non-surgical approach that uses an endoscope for your weight loss treatment, instead of external incisions (cuts). An endoscope is a thin, flexible tube that helps a doctor view your digestive system. Endoscopic procedures are considered very safe and less risky than traditional surgery.

Brigham and Women's Hospital was a site in the initial patient registry for this procedure. We currently are the only site on the East coast that is approved to perform this procedure.

What is ROSE?

ROSE is a revision procedure, meaning it's only appropriate for certain patients who’ve already had gastric bypass surgery.

ROSE is an endoscopic plication treatment for gastric bypass patients who are struggling with weight regain. When weight regain happens, it can be due to some stretching of the stomach pouch (the smaller stomach created in the gastric bypass procedure) or a stretching of the outlet, which is where your stomach and small intestine meet. ROSE is an endoscopic procedure that helps restore the stomach pouch and outlet to the size they were following a gastric bypass. ROSE works by using sutures to create plications (folds) to decrease the volume of the stomach pouch.

How is ROSE performed?

While under anesthesia, your doctor inserts the endoscopic system into your mouth and passes it into your gastric pouch. The system has several components that are used together to fold and fuse the stomach. Several plications are placed to make the pouch smaller.

ROSE typically takes less than an hour to complete. ROSE is a minimally invasive endoscopic procedure, so it doesn't require any incisions on the outside of your body and you won't have any external scars. The recovery time is also much faster than traditional surgery.

How much weight can you expect to lose from ROSE?

Your expected weight loss can vary with ROSE, and it likely depends on how much weight was regained after gastric bypass. ROSE is very effective at restoring the structure of the stomach produced by the original gastric bypass surgery, which can help reinitiate weight loss.

What is recovery like after ROSE?

After ROSE, you will need to stay overnight at the hospital and take a few days off from work to recover. During recovery, you are first prescribed a special liquid meal plan. Over time, you transition to a soft food plan (including easy-to-eat foods, like oatmeal, bananas, and soft-cooked rice) and then return to normal eating. For a ROSE procedure, there is no lifting restriction.

Are there any additional health benefits to treatment, besides weight loss?

You might experience better health, like improvements in weight-related health conditions. These can include sleep apnea, high blood pressure, type 2 diabetes, fatty liver and dyslipidemia. Dyslipidemia is when you have abnormal amounts of lipids (fats) in your blood. In some cases, these conditions may even resolve completely.

Am I a candidate for ROSE?

You must have had a previous gastric bypass with an enlarged pouch to qualify for this procedure. There are no strict body mass index (BMI) criteria for this procedure.

How do I improve my health before the procedure and prepare for ROSE?

You can meet with your doctor to ask any questions you may have about ROSE. We know it can be depressing or discouraging for some patients to regain weight after a gastric bypass procedure. We offer psychological support to patients who are undergoing revision treatments by collaborating with mental health specialists. We also have dieticians who can work with you before and after the procedure to adopt and maintain a healthy lifestyle.

Do you offer long-term weight management support?

Yes. We take a collaborative approach to treatment that combines the expertise of many different specialists, including dietitians and mental health professionals. Our team-based approach helps us offer a very high quality of care.

Which doctors offer ROSE?

Christopher Thompson, MD, MSc, AGAF, FASGE, FACG
Co-director of Center for Weight Management and Wellness
Director of Endoscopy
Director of Bariatric Endoscopy

Pichamol Jirapinyo, MD, MPH, ABOM
Associate Director of Bariatric Endoscopy
Director of Bariatric Endoscopy Fellowship

How do I schedule an appointment to learn more about ROSE?

If you would like more information or would like to schedule an appointment with a Brigham doctor, you can call us at 617-525-3597 or fill out our appointment request form.

I’m a physician. How do I refer a patient for treatment?

Physicians who are looking to refer a patient can call 617-525-3597 or email us at

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