The Effect of Extended Use of the EPITOMEE CAPSULE (ELECT)

Prior treatment

• Currently receiving chronic steroid or immunosuppressive therapy
• Intending to undergo gastric surgery or gastric banding during the study period.
• Any medications known to be gastric irritants for 4 weeks prior to study start
• Subjects for whom any medications for hypertension or hyperlipidemia have been initiated within 1 month prior to study start
• Subjects for whom any anti-seizure or anti-arrhythmic medications have been initiated within 6 months prior to study start
• Subjects who are habitual laxative users or using prescription medication for chronic constipation

Other illness

• Currently suffering from structural or functional disorders of the esophagus that may impede passage of the device through the gastrointestinal tract, including: Barrett's esophagus, esophagus motility disorder, esophagitis, dysphagia, achalasia, stricture/stenosis, esophageal varices, esophageal diverticula, esophageal perforation, esophageal motility disorder, esophageal chest pain disorders or any other disorder of the esophagus
• Currently suffering from swallowing disorder, or drug refractory esophageal reflux symptoms
• Currently suffering from structural or functional disorders of the stomach including, gastric ulcer, chronic gastritis, gastric varices, hiatal hernia (\> 2 cm), cancer or any other disorder of the stomach or any symptoms of chronic upper abdominal pain, chronic nausea, chronic vomiting, chronic dyspepsia or symptoms suggestive of gastroparesis, including post-prandial fullness or pain, post-prandial nausea or vomiting or early satiety.
• Currently suffering from duodenal ulcer, small bowel diverticula (diverticulitis), intestinal varices, intestinal stricture/stenosis, small bowel obstruction, or any other obstructive disorder of the gastrointestinal (GI) tract
• Currently having irritable bowel syndrome, radiation enteritis or other inflammatory bowel disease, such as Crohn's disease
• Subjects with congestive heart failure (New York Heart Association (NYHA) Class II, III or IV; myocardial infarction (MI) and/or revascularization (e.g. coronary bypass graft/stent) within 12 months of study start
• Currently having poorly controlled hypertension (≥ 160 mmHg systolic or ≥ 100 mmHg diastolic)
• Any other condition that, in the opinion of the investigator, would interfere with subject participation, may confound the study results, or interfere with compliance with the study (e.g., psychosocial issues, renal disease, hepatic disease, pulmonary disease or cancer disease).

Lab values

• Subjects with Fasting Plasma Glucose ≥126 mg/dL or HbA1c ≥ 6.5% based on blood test results at 24 week visit of the core study
• Subjects for whom any anti-platelet drugs beside low dose of Aspirin, have been initiated within 6 months prior to study start

Other

• Currently having ongoing symptoms suggestive of intermittent small bowel obstruction, such as recurrent bouts of post-prandial abdominal pain, nausea or vomiting
• Subjects presenting poor abilities and inconsistencies in using the study app during the core study.

• Signing an informed consent form prior to any study activity
• Completed 24 weeks of the core study with maximum of two unattended visits
• Had at least 3% weight loss in week 24 visit of the core study
• Non-pregnant, evidenced by a negative urine dipstick pregnancy test by visit 24 week of the core study
• Females will be either surgically sterile or postmenopausal or agree to continue using an accepted method of birth control during the study
• Subjects with prediabetes could be untreated or treated with a stable dose of metformin up to 2000 mg/dL inclusive, for at least 1 month prior to entry into the study
• Currently not using and willingness to avoid non-steroidal anti-inflammatory drugs (NSAIDs) including Diclofenac, Ibuprofen, Naproxen excluding the use of low dose aspirin (75-100 mg) or Celebrex 200-400 mg.
• Able and willing to continue the lifestyle intervention program as required in the core study including diet and physical activity
• Subjects must have a primary care physician (PCP) who is responsible for providing routine care
• Subjects must have cellphone and internet service to communicate with study staff
• Study subjects must be willing to notify the staff of any change in their medical health (including surgeries) or change in drug treatments (addition of drugs, stopping of drugs, or change in drug dose) during the course of the study
• Subjects must be willing to avoid medications or other substances known to affect weight changes during the study
• Subjects on psychiatric medications are clinically well-controlled with a stable psychiatric medication dose for 3 months prior to entry into the extension study