Endoscopic Suturing System for Tissue Apposition

Inclusion Criteria Subjects must fulfill the following criteria to be entered in this study: * Review and sign informed consent; * Between 21 and 65 years of age (inclusive) at time of trial enrollment; * Documented Roux-en-Y Gastric Bypass (RYGB) surgery date * Documented baseline weight at the time of RYGB procedure; * \> 12 months post RYGB); * Body mass Index (BMI) \> 30 and at least 20 pounds in excess of post-RYGB weight nadir; * Patients initially achieved at least 50% excess weight loss (EWL) post RYGB; * Visible anastomotic junction (between gastric pouch and the Roux-limb); * Stoma size at screening \> 15mm; and * Negative serum pregnancy test for women of childbearing potential. Exclusion Criteria Subjects will be excluded from the trial for any of the following: * Documented history of esophageal pathology (e.g., esophageal varices, Barrett's Esophagus); * American Anesthesia Association (ASA) Class IV or V and/or any contraindications to monitored anesthesia; * Documented history of GJ anastomosis stricture (within 6 months); * Documented history of previous RYGB revision; * Presence or documented presence of gastric/duodenal ulcers; * Presence of sepsis; * Medical or physical endoscopic contraindications, including esophageal varices or bleeding, laryngeal perforation, trauma to pharynx, aspiration pneumonia, acute peritonitis, and other conditions where general endoscopic techniques and/or placement of overtube are contraindicated; * Chronic Non-Steroidal Anti-Inflammatory Drug (NSAID) use (subjects taking a single aspirin tablet per day for cardioprotection are considered acceptable); * Uncontrolled diabetes; * Physical or psychological condition which would impair trial participation per investigator discretion; * Binge-eating or similar eating disorders; * Unable or unwilling to attend follow-up visits and examinations; * Concurrent surgical procedure (intra-operative exclusion during ESS procedure); * Participation in any other investigational device or drug trial within 30 days prior to enrollment; or * Any condition, which precludes compliance with the trial.