well as other novel patterns; nonetheless, to date, no suture pattern has been proven to be superior for weight loss. Regardless of suture pattern, creation of the ESG focuses on tissue imbrication along the greater curvature of the stomach. The fundus is typically avoided due to the relatively thinner wall compared to the gastric body to avoid complications from the procedure. Providers and locations for ESG performance Accredited advanced fellowship training programs in ESG and other endoscopic bariatric therapies are currently rare, and competency in ESG is typically achieved through proctoring by experts after completion of an accredited gastroenterology or surgical training program. Studies have reported that efficiency with performance of ESG and improved weight loss outcomes occur after approximately 35-38 cases. Mastery was reported in one study to occur after 55 cases. While early performance of the ESG has traditionally been carried out in university-affiliated/academic centers, ESG has been shown to be feasible and safe when performed in the community setting. Outcomes The primary measures of weight loss outcomes for endoscopic bariatric therapies include total body weight loss (percentage of pre-procedure weight lost by a certain time point) and excess weight loss (percentage of pre-procedure weight above ideal body weight that is lost by a certain time point). The Preservation and Incorporation of Valuable Endoscopic Innovation thresholds is an expert panel with gastroenterologists and surgeons from the American Society for Gastrointestinal Endoscopy and The American Society for Metabolic and Bariatric Surgery, and in 2015, this panel recommended that any new endoscopic therapy for weight loss should have an excess weight loss exceeding 25% and a serious adverse event rate less than 5%. Total body weight loss thresholds were not defined but are generally considered meaningful in novel endoscopic bariatric therapies if exceeding 5%. Multiple studies of ESG have shown that this therapy satisfies these criteria, as outlined below. Weight loss outcomes Multicenter ESG Randomized Trial (MERIT) The recently published MERIT study is the first and only randomized controlled trial of the ESG for treatment of obesity and included 209 adult subjects with class I and II obesity (BMI 30–40 kg/m2). It was conducted from Dec. 2017 to Jun. 2019, spanned nine centers in the United States, and comprised 85 adults in the ESG arm and 124 adults in the control arm (lifestyle modification only). Subjects in the ESG arm lost 13.6% of body weight and 49.2% of excess body