Our initial technique involved simple placement of the BariClip with non-absorbable suture fixation to the anterior and posterior gastric wall. To reduce the potential risk of slippage and increase weight loss we decided to add a gastro-gastric plication of the gastric wall covering the BariClip at those areas where the gastric wall can slip through between the limbs of the clip. These areas are anteriorly at the top part of the clip where two interrupted gastro-gastro sutures are placed creating a kind of upper wrap and posteriorly around the drainage area of the clip where an additional suture is placed around free silicone. In addition, we performed a partial plication of the antrum in order to increase distal restriction especially in patients having a wide antrum [1].