Hormonal and Microbiota Modulation After Endoscopic Sleeve Gastroplasty

Inclusion Criteria: * Male or female, age ≥ 18 years * BMI between 30 and 40 kg/m² * With or without obesity-related comorbidities (hypertension, diabetes, -obstructive sleep apnea, etc.) * Indication for ESG (Endoscopic Sleeve Gastroplasty) or surgical sleeve gastrectomy validated in a multidisciplinary team meeting * Patient with an indication to undergo CT scan and scintigraphy * Written informed consent * Affiliation with a health insurance system Exclusion Criteria: * Patient receiving anti-obesity treatment (GLP-1 analogs, multi-agonists) * History of prior gastric surgery * History of gastric or distal esophageal cancer * History of gastric dysplasia * Presence of a hiatal hernia \> 2 cm * Contraindication to general anesthesia, including: * Severe coagulation disorders, including uncontrolled congenital or acquired hemostasis disorders, severe thrombocytopenia (platelets \< 50 G/L), non-interruptible anticoagulant or antiplatelet therapy according to current guidelines, uncorrected INR \> 1.5 * Hemodynamic instability, defined as persistent hypotension or shock, uncontrolled cardiac arrhythmias, or need for vasopressor support * Decompensated cardiac disease, including uncontrolled heart failure (NYHA III-IV), unstable ischemic heart disease or recent acute coronary syndrome, untreated severe valvular disease, uncontrolled severe hypertension * Decompensated respiratory disease, including acute or severe chronic respiratory failure not stabilized, uncontrolled severe COPD, untreated severe obstructive sleep apnea, persistent hypoxemia requiring high-flow oxygen therapy * Any other clinical condition considered incompatible with general anesthesia or endoscopy by the anesthesiologist or investigator, according to current guidelines and patient safety considerations Significant or unstable renal insufficiency, or history of severe reaction to iodinated contrast agents * Participation in another clinical research study, except for non-interventional studies * Patient under legal protection (guardianship, curatorship, or judicial protection) * Physical inability to provide written informed consent * Rare forms of obesity of genetic and/or central origin (e.g., associated with craniopharyngioma) * Pregnancy or breastfeeding * State medical aid (AME)