Inclusion Criteria:  Age 22-65 years at screening Body mass index (BMI) ≥35 and ≤50 Patient is ≥12 months but ≤ 60 months post sleeve gastrectomy who have inadequate weight loss or weight regain. Weight stable over 3-month period Negative H. pylori breath test Agrees to refrain from any type of additional bariatric or reconstructive surgery that would affect body weight for a duration of 2 years If female, subject must commit to not becoming pregnant for 24 months and agree to use contraception during this period Able to understand and sign informed consent documents.  Exclusion Criteria:  Known or suspected allergy to nickel or titanium or nitinol Contraindication to general anesthesia Previous technical difficulty or failed endoscopy or contraindication to endoscopy of upper GI series Any previous major surgery on the stomach (excluding sleeve gastrectomy), duodenum, hepatobiliary tree (excluding gallbladder), pancreas, or right colon. Clinically significant findings during screening endoscopy at target region for compression anastomosis Uncontrolled hypertension Pre-existing severe comorbid cardio-respiratory disease History of type 1 diabetes or poorly controlled type 2 diabetes Abnormal liver biochemistry History of chronic gastrointestinal disease Specific genetic or hormonal cause of obesity Recent tobacco/nicotine product cessation (within 3 months prior)