Patient description: A 58-year-old African-American woman presents to the ER with episodic pressing/burning anterior chest pain that began two days earlier for the first time in her life. The pain started while she was walking, radiates to the back, and is accompanied by nausea, diaphoresis and mild dyspnea, but is not increased on inspiration. The latest episode of pain ended half an hour prior to her arrival. She is known to have hypertension and obesity. She denies smoking, diabetes, hypercholesterolemia, or a family history of heart disease. She currently takes no medications. Physical examination is normal. The EKG shows nonspecific changes.

Clinical trial eligibility criteria: eligible ages (years): 18.0-50.0,  Obesity for in main ACE stapling study Subject must be able to understand and be willing to sign an informed consent document Subject must be willing and able to participate in all aspects of the study and agree to comply with all study requirements for the duration of the study. This includes availability of reliable transportation and sufficient time to attend all follow-up visits Subject has a BMI of 40 or 30 to 39.9 plus one or more co-morbid diseases expected to improve with weight loss, including but not limited to hypertension, dyslipidemia, obstructive sleep apnea, or diabetes mellitus Subject must be fully ambulatory, without chronic reliance on walking aids such as crutches, walkers or a wheelchair Subject must be of sufficient and stable medical health, as evaluated by the Principal Investigator Subject must have a primary care physician that will manage the subject for any co-morbid conditions throughout the study Subject must have failed standard obesity therapy of diet, exercise, behaviour modification, and pharmacologic agents either alone or in combination, as assessed by an interview with a member of the study team at baseline Subject agrees to refrain from any type of reconstructive surgery that may affect body weight such as mammoplasty or abdominal lipoplasty or liposuction, during the trial  Main study Subject has history of/or signs and/or symptoms of gastro-duodenal ulcer disease Subject has poorly controlled diabetes as indicated by the lack of stable diabetes medications and doses over the last month, or has a history of diabetes for greater than 10 years Subject has had significant weight loss in the last 3 months, or between baseline and the study procedure Subject has a history or is diagnosed with eating disorders Subject has history of peptic ulcer and tests positive for H. pylori, unless treated before the procedure Subject has symptomatic congestive heart failure, cardiac arrhythmia or unstable coronary artery disease Subject has pre-existing respiratory disease such as chronic obstructive pulmonary disease (COPD), pneumonia or cancer Subject has significant esophageal disease including Zenker's diverticulum, grade 3-4 reflux esophagitis, stricture, Barrett's esophagus, esophageal cancer, esophageal diverticulum, dysphagia, achalasia, or symptoms of dysmotility Subject is observed during EGD to have heavily scarred, malignant or poor quality/friable tissue in areas of the stomach where plications are to be placed