Endoscopic Sleeve Gastroplasty for Obesity and Microbiota Randomized Trial

This is an interventional, open-label, randomized (2:1), standard medical therapy-controlled trial. Subjects in the standard therapy group will be given the opportunity to undergo the active endoscopic treatment after 6 months of follow up (open label extension) if they will not achieve an adequate result on body weight. All patients will be followed until the planned end of the study after 36 months from the ESG procedure. To study the effects of endoscopic gastroplasty on weight, metabolic risk factors, quality of life, satiety, gastrointestinal motility and gut microbiota compared to standard medical treatment control group. Primary endpoint: \- Total body weight loss (%) Secondary endpoints: * Metabolic risk factors (e.g. lipid profile) and anthropometric measurements (e.g hip and waist circumference) * Body composition * Quality of life * Gastroesophageal reflux disease * Non-Alcoholic Fatty Liver Disease (NAFLD) * Non- Alcoholic-Steato-Hepatitis (NASH) * Satiety * Gut microbiota Exploratory endpoints: * Gut hormones e.g. glucagon-like peptide 1, PYY and ghrelin * Gastrointestinal motility