Surgical Intervention in Bariatric Patients: Excess Weight Loss in the Morbidly Obese Following Gastric Plication

1. Subject is willing to give consent and comply with evaluation and treatment schedule (for female patients, this includes agreement to use a reliable (per investigator) form of birth control for the duration of the trial);
2. 18 to 65 years of age (inclusive);

3. Subject meets ASMBS and NIH criteria: (consensus.nih.gov)

   BMI ³ 40 kg/m2 and £ 50 kg/m2; or, BMI 35-40 kg/m2 with one or more significant co-morbid medical conditions which are generally expected to be improved, reversed, or resolved by weight loss, including:

   • Hyperlipidemia
   • Mild obstructive sleep apnea (per Investigator discretion)
   • Hypertension
   • Osteoarthritis of the hip or knee per investigational site's criteria for which the subject is being treated;
4. ASA Class I - III;
5. Agree to refrain from any type of weight-loss drug (prescription or OTC) or elective procedure that would affect body weight for the duration of the trial;
6. HbA1C \< 11%; and
7. For subjects who have Type 2 diabetes, medication regimen is no more complex (2 oral medications) than oral metformin plus one oral sulfonylurea plus once daily insulin injection.

Exclusion Criteria:

1. Documented history of drug and/or alcohol abuse within two (2) years of the Screening Visit;
2. Previous malabsorptive or restrictive procedures performed for the treatment of obesity;
3. Scheduled concurrent surgical procedure, with the exception of SOC liver biopsy;
4. Women of childbearing potential who are pregnant or lactating at the time of screening or at the time of surgery;
5. Psychiatric disorders that may affect compliance with the clinical trial, including dementia, active psychosis, severe depression requiring > 2 medications, or history of suicide attempts;
6. Participation in any other investigational device or drug study (non-survey based trial; long-term enrollment in such studies as requiring periodic laboratory tests, etc., would be allowed) within 12 weeks of enrollment;

7. Any condition which precludes compliance with the study, including:

   1. Inflammatory diseases of the gastrointestinal tract, including severe intractable esophagitis, gastric ulceration, duodenal ulceration, or specific inflammation such as Crohn's disease or ulcerative colitis that have been active within the past 10 years;
   2. Congenital or acquired anomalies of the GI tract, including atresias or stenosis;
   3. Severe cardiopulmonary disease or other serious organic disease that makes the subject a high-risk surgical candidate;
   4. Uncontrolled hypertension;
   5. Portal hypertension;
   6. Chronic or acute upper gastrointestinal bleeding conditions (e.g., gastric or esophageal varices);
   7. Cirrhosis;
   8. Congenital or acquired intestinal telangiectasia;
   9. Esophageal or gastric disorders including moderate severe preoperative reflux, dysmotility, or Barrett's esophagus;
   10. Presence of hiatal hernia greater than 2cm in length, with the exception of a small sliding hiatal hernia previously undiagnosed and discovered during the surgical procedure;
   11. Prior surgery of the foregut including hiatal hernia repair or prior gastric surgery;
   12. Known history of clotting disorders, hemoglobinopathies, and hemolytic disorders, including pulmonary embolus and Deep Vein Thrombosis;
   13. Pancreatitis;
   14. Gallstones (confirmed via ultrasound);
   15. Immunocompromised such as that resulting from chronic oral steroid use, chemotherapeutic agents, or immune deficiency disorders;
   16. Use of thiazolidinediones ("glitazones"), or
   17. Conditions that, in the opinion of the investigator, may jeopardize the subject's well-being and/or the soundness of this clinical study;
8. History or presence of pre-existing autoimmune connective tissue disease; and
9. Use of prescription or over the counter weight reduction medications or supplements within thirty days of the Screening Visit or the duration of study participation.