Endoscopic sleeve gastroplasty (ESG) is an option for obese patients who have been unable to achieve significant weight loss through diet and lifestyle modifications. This includes individuals with a Body Mass Index (BMI) of 35 kg/m² or higher, or those with a BMI of 30 kg/m² or higher who also have obesity-related comorbidities such as diabetes or hypertension. Patients should have previously attempted and failed to achieve sustained weight loss through supervised dietary programs, similar to the criteria for laparoscopic bariatric procedures. Before the procedure, all candidates undergo a comprehensive multidisciplinary evaluation involving specialists in psychiatry, endocrinology, and internal medicine. This includes a full battery of diagnostic tests and an anesthesia consultation. The procedure proceeds only if no contraindications, medical or psychological, are identified during this thorough assessment. Patients with pre-existing gastric conditions must undergo appropriate treatment and resolution of these issues prior to ESG. However, the presence of a tumor is an absolute contraindication for this procedure.