Background: Alternative and less invasive methods for laparoscopic sleeve gastrectomy include endoscopic sleeve gastroplasty (ESG), where the stomach is transformed into a narrow tube by using an endoscopic suturing device. Despite satisfying weight loss results, severe adverse events, including gastric perforation, have occurred. Case Presentation: This case report describes a 38-year-old woman with acute abdominal pain four days after ESG. An emergency laparoscopic exploration revealed a stomach perforation fixed to the anterior abdominal wall by a suture anchor of the gastroplasty. Conclusion: A full-thickness perforation harming neighboring organs and structures is a possible complication after ESG. Therefore, this procedure should only be performed if morbidity can be monitored during the procedure to avoid situations where dangerous complications remain unrecognized for too long.

Keywords: gastroplasty – morbidity – endoscopy, gastrointestinal – bariatric surgery – case report.