Study Overview: This study aims to track how well a weight-loss procedure called gastric mucosal ablation with endoscopic sleeve gastroplasty (ESG) works. ESG is a non-surgical method to reshape the stomach, making it smaller to help people eat less and lose weight. The study will see if combining ESG with another technique called gastric fundus ablation helps people lose more weight. The fundus is part of the stomach that produces a hormone called ghrelin, which increases hunger. The study will record results from multiple sites and see if this combined method is safe and effective.

• Duration: Long-term follow-up to track weight loss and safety.
• Participation: Must be 18-65 years old, have a BMI between 28-55, and agree to diet changes.
• Safety: Previous studies showed no serious side effects.

Eligibility: Participants must agree to use birth control if they can have children, and cannot be pregnant, breastfeeding, or have certain eating disorders. You must not be on weight-loss drugs or have psychological issues affecting lifestyle changes.