ENLIGHT Trial: ESG With Fundal Mucosal Ablation

Inclusion Criteria: 1. Male or female subjects aged ≥18 years 2. Subjects with a BMI ≥30 kg/m² 3. Subjects have a history of failure of at least one prior weight loss attempt, including but not limited to dietary modification, physical exercise, behavioral modification, pharmacologic therapy (alone or in combination), or other non-surgical weight reduction methods. 4. Willing and able to comply with all study requirements, including but not limited to signing a written informed consent form prior to participation, routine follow-up visit schedule, completing all required laboratory, imaging, and additional assessments, and participating in dietary counseling sessions. 5. Women of childbearing potential (i.e., not postmenopausal and not surgically sterilized) must agree to use adequate and effective contraception methods throughout the study period. 6. Able to travel to visit the study site and have access to the internet to facilitate remote follow-up activities, as applicable. Exclusion Criteria: 1. Prior gastric or bariatric surgery/procedure that may affect the anatomy or feasibility of the intervention, (e.g; prior Roux-en-Y gastric bypass, laparoscopic sleeve gastrectomy, endoscopic sleeve gastroplasty). 2. Clinically significant structural abnormality that may increase procedural risk or interfere with endoscopic access 3. Conditions associated with increased bleeding (e.g., severe coagulopathy, severe immunocompromise). 4. Conditions that may affect weight, eating behavior, (e.g; GI motility disorders, gastroparesis, chronic abdominal pain, eating disorders, or active psychological conditions). 5. Pregnancy, breastfeeding, or any other condition that, in the opinion of the investigator or treating physician, would make participation unsafe or interfere with study procedures. 6. Other cases deemed by the examining physician as unsuitable for safe treatment.