Hybrid Argon Plasma Coagulation and Endoscopic Sleeve Gastroplasty Trial

Inclusion Criteria: * BMI ≥ 30 and ≤40 kg/m² * Willingness to comply with the substantial lifelong dietary restrictions required by the procedure. * History of failure with non-surgical weight-loss methods. * Willingness to follow protocol requirements, including signed informed consent, routine follow-up schedule, completing laboratory tests, and completing diet counseling. * Residing within a reasonable distance from the investigator's office and able to travel to the investigator to complete all routine follow-up visits. * Ability to give informed consent. * Women of childbearing potential (i.e., not post-menopausal or surgically sterilized) must agree to use adequate birth control methods. Exclusion Criteria: * History of foregut or gastrointestinal (GI) surgery (except uncomplicated cholecystectomy or appendectomy). * Prior gastrointestinal surgery with sequelae, i.e. obstruction, and/or adhesive peritonitis or known abdominal adhesions. * Prior open or laparoscopic bariatric surgery. * Prior surgery of any kind on the esophagus, stomach, or any type of hiatal hernia surgery. * Any inflammatory disease of the gastrointestinal tract including severe (LA Grade C or D) esophagitis, Barrett's esophagus, gastric ulceration, duodenal ulceration, cancer, or specific inflammatory disease such as Crohn's disease or celiac disease. * Potential upper gastrointestinal bleeding conditions such as esophageal or gastric varices, congenital or acquired intestinal telangiectasis, or other congenital anomalies of the gastrointestinal tract such as atresias or stenoses. * Gastrointestinal stromal tumors, history of premalignant gastric lesions (intestinal metaplasia), history of familial and nan-familial adenomatous syndromes. * A gastric mass or gastric polyps \> 1 cm in size. * A hiatal hernia \> 4cm of axial displacement of the z-line above the diaphragm or severe or intractable gastro-esophageal reflux symptoms. * A structural abnormality in the esophagus or pharynx such as a stricture or diverticulum that could impede passage of the endoscope. * Achalasia or any other severe esophageal motility disorder * Severe coagulopathy. * Insulin-dependent diabetes (either Type 1 or Type 2) or a significant likelihood of requiring insulin treatment in the following 12 months or a HgbA1C≥9. * Subjects with any serious health condition unrelated to their weight that would increase the risk of endoscopy. * Chronic abdominal pain. * Motility disorders of the GI tract such as gross esophageal motility disorders, gastroparesis or intractable constipation. * Hepatic insufficiency or cirrhosis. * Use of an intragastric device prior to this study due to the increased thickness of the stomach wall preventing effective suturing. * Active psychological issues preventing participation in a life-style modification program as determined by a psychologist. * Patients unwilling to participate in an established medically supervised diet and behavior modification program, with routine medical follow-up. * Patients receiving daily prescribed treatment with high dose aspirin (\> 81mg daily), anti-inflammatory agents, anticoagulants, or other gastric irritants. * Patients who are unable or unwilling to take prescribed proton pump inhibitor medication. * Patients who are pregnant or breast-feeding. * Patients currently taking weight-loss medications or other therapies for weight loss within the prior 6 months. * Subjects with severe cardiopulmonary disease or other serious organic disease which might include known history of coronary artery disease, myocardial infarction within the past 6 months, poorly controlled hypertension, required use of NSAIDs. * Subjects taking medications on specified hourly intervals that may be affected by changes to gastric emptying, such as anti-seizure or anti-arrhythmic medications. * Subjects who are taking corticosteroids, immunosuppressants, and narcotics. * Symptomatic congestive heart failure, cardiac arrhythmia, or unstable coronary artery disease. * Pre-existing respiratory disease such as moderate or severe chronic obstructive pulmonary disease (COPD) requiring steroids, pneumonia, or cancer. * Diagnosis of autoimmune connective tissue disorder (e.g. Systemic lupus erythematosus, scleroderma) or immunocompromised. * Specific diagnosed genetic disorder such as Prader Willi syndrome. * Eating disorders including night eating syndrome (NES), bulimia, binge eating disorder, or compulsive overeating. * Known history of endocrine disorders affecting weight such as uncontrolled hypothyroidism. * At the discretion of the PI for subject safety * If minority inclusion population target of 10% has not been reached by the 90% enrollment mark (example 21 of 24 subjects), the remaining enrollments will be reserved for minority subjects (example 3 of 24 subjects).