Endoscopic bariatric therapies offer minimally invasive options for patients with obesity who are not candidates for surgery. We report a novel combined approach integrating Endoscopic Sleeve Gastroplasty (ESG) with Gastric Mucosal Ablation (GMA) of the fundus using the MOVIVA probe. The device allows submucosal injection to protect deeper layers and controlled mucosal ablation via Argon Plasma Coagulation, aiming to reduce ghrelin-producing cells. A 54-year-old man (BMI 44 kg/m²) underwent MOVIVA-assisted fundic ablation followed by ESG with the OverStitch NXT system. The procedure was uneventful, and oral intake resumed the next day. At one month, the patient reported early satiety and achieved 16.5% total body weight loss. This combined strategy may enhance metabolic outcomes by coupling gastric restriction with hormonal modulation.