Apollo Endosurgery (APEN) 10-Q 8 Nov 18 2018 Q3 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	9 Months Ended
	Sep. 30, 2018	Oct. 31, 2018
Document and Entity Information [Abstract]
Entity Registrant Name	APOLLO ENDOSURGERY, INC.
Entity Central Index Key	1,251,769
Document Type	10-Q
Document Period End Date	Sep. 30, 2018
Amendment Flag	false
Current Fiscal Year End Date	--12-31
Entity Filer Category	Non-accelerated Filer
Entity Common Stock, Shares Outstanding		21,893,509
Entity Small Business	true
Entity Emerging Growth Company	false
Document Fiscal Year Focus	2,018
Document Fiscal Period Focus	Q3

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Sep. 30, 2018	Dec. 31, 2017
Current assets:
Cash and cash equivalents	$ 28,437	$ 30,513
Accounts receivable, net of allowance for doubtful accounts of $585 and $452, respectively	10,269	11,729
Inventory, net	13,308	14,343
Prepaid expenses and other current assets	1,122	1,015
Total current assets	53,136	57,600
Restricted cash	1,017	905
Property and equipment, net of accumulated depreciation of $8,111 and $6,658, respectively	6,688	6,885
Goodwill	6,828	6,828
Intangible assets, net of accumulated amortization of $33,926 and $28,415, respectively	31,603	36,421
Other assets	367	422
Total assets	99,639	109,061
Current liabilities:
Accounts payable	13,359	18,327
Accrued expenses	8,634	7,500
Total current liabilities	21,993	25,827
Long-term debt	31,028	33,321
Total liabilities	53,021	59,148
Commitments and contingencies
Stockholders' equity:
Common stock; $0.001 par value; 100,000,000 shares authorized; 21,893,174 and 17,291,209 shares issued and outstanding at September 30, 2018 and December 31, 2017, respectively	22	17
Additional paid-in capital	248,761	225,122
Accumulated other comprehensive income	2,290	1,795
Accumulated deficit	(204,455)	(177,021)
Total stockholders' equity	46,618	49,913
Total liabilities and stockholders' equity	$ 99,639	$ 109,061

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Sep. 30, 2018	Dec. 31, 2017
Statement of Financial Position [Abstract]
Allowance for doubtful accounts	$ 585	$ 452
Accumulated depreciation	8,111	6,658
Accumulated amortization	$ 33,926	$ 28,415
Common stock, par value (USD per share)	$ 0.001	$ 0.001
Common stock, shares authorized (shares)	100,000,000	100,000,000
Common stock, shares issued (shares)	21,893,174	17,291,209
Common stock, shares outstanding (shares)	21,893,174	17,291,209

Condensed Consolidated Statemen

Condensed Consolidated Statements of Operations and Comprehensive Loss - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Income Statement [Abstract]
Revenues	$ 14,141	$ 16,544	$ 45,672	$ 48,170
Cost of sales	6,400	6,012	19,560	17,744
Gross margin	7,741	10,532	26,112	30,426
Operating expenses:
Sales and marketing	7,344	7,978	25,078	24,832
General and administrative	3,021	2,858	9,589	10,293
Research and development	3,671	2,178	9,281	6,420
Amortization of intangible assets	1,807	1,803	5,411	5,444
Total operating expenses	15,843	14,817	49,359	46,989
Loss from operations	(8,102)	(4,285)	(23,247)	(16,563)
Other expenses:
Interest expense, net	1,001	1,013	2,980	3,529
Other expense (income)	620	(451)	1,085	(283)
Net loss before income taxes	(9,723)	(4,847)	(27,312)	(19,809)
Income tax expense	36	55	122	168
Net loss	(9,759)	(4,902)	(27,434)	(19,977)
Other comprehensive income (loss):
Foreign currency translation	498	(227)	495	158
Comprehensive loss	$ (9,261)	$ (5,129)	$ (26,939)	$ (19,819)
Net loss per share, basic and diluted (USD per share)	$ (0.45)	$ (0.32)	$ (1.44)	$ (1.62)
Shares used in computing net loss per share, basic and diluted (shares)	21,885,158	15,481,872	19,080,400	12,310,426

Condensed Consolidated Statem_2

Condensed Consolidated Statements of Changes in Stockholders’ Equity - 9 months ended Sep. 30, 2018 - USD ($) $ in Thousands	Total	Common Stock [Member]	Additional Paid-in Capital [Member]	Accumulated Other Comprehensive Income [Member]	Accumulated Deficit [Member]
Beginning balance at Dec. 31, 2017	$ 49,913	$ 17	$ 225,122	$ 1,795	$ (177,021)
Beginning balance, shares at Dec. 31, 2017	17,291,209	17,291,209
Exercise of common stock options	$ 738		738
Exercise of common stock options, shares		275,805
Issuance of restricted stock units, shares		17,070
Issuance of common stock, net of issuance costs of $1,843	21,857	$ 5	21,852
Issuance of common stock, net of issuance costs of $1,843, shares		4,309,090
Stock based compensation	1,049		1,049
Foreign currency translation	495			495
Net loss	(27,434)				(27,434)
Ending balance at Sep. 30, 2018	$ 46,618	$ 22	$ 248,761	$ 2,290	$ (204,455)
Ending balance, shares at Sep. 30, 2018	21,893,174	21,893,174

Condensed Consolidated Statem_3

Condensed Consolidated Statements of Changes in Stockholders’ Equity (Parenthetical) $ in Thousands	9 Months Ended
	Sep. 30, 2018USD ($)
Statement of Stockholders' Equity [Abstract]
Issuance costs	$ 1,843

Condensed Consolidated Statem_4

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017
Cash flows from operating activities:
Net loss	$ (27,434)	$ (19,977)
Adjustments to reconcile net loss to net cash used in operating activities:
Depreciation and amortization	7,024	7,260
Amortization of deferred financing costs	269	257
Non-cash interest expense	291	493
Provision for doubtful accounts receivable	174	106
Change in inventory reserve	367	199
Stock based compensation	1,049	538
Foreign currency exchange on short-term intercompany loans	906	(592)
Changes in operating assets and liabilities:
Accounts receivable	1,088	(1,414)
Inventory	439	(729)
Prepaid expenses and other assets	(84)	885
Accounts payable and accrued expenses	(3,007)	3,299
Net cash used in operating activities	(18,918)	(9,675)
Cash flows from investing activities:
Purchases of property and equipment	(1,965)	(1,258)
Purchases of intangibles and other assets	(754)	(419)
Net cash used in investing activities	(2,719)	(1,677)
Cash flows from financing activities:
Proceeds from exercise of stock options	738	119
Proceeds from the issuance of common stock	21,857	33,584
Payments of deferred financing costs	(353)	0
Payment of long-term debt	(2,500)	(7,000)
Net cash provided by financing activities	19,742	26,703
Effect of exchange rate changes on cash	(69)	107
Net increase/(decrease) in cash, cash equivalents and restricted cash	(1,964)	15,458
Cash, cash equivalents and restricted cash at beginning of year	31,418	20,041
Cash, cash equivalents and restricted cash at end of period	29,454	35,499
Supplemental disclosure of cash flow information:
Cash paid for interest	2,738	2,875
Cash paid for income taxes	$ 36	$ 178

Organization and Business Descr

Organization and Business Description	9 Months Ended
	Sep. 30, 2018
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Organization and Business Description	Organization and Business Description Apollo Endosurgery, Inc. is a Delaware corporation with both domestic and foreign wholly-owned subsidiaries. Throughout these Notes "Apollo" and the "Company" refer to Apollo Endosurgery, Inc. and its consolidated subsidiaries. Apollo is a medical technology company primarily focused on the design, development, and commercialization of innovative medical devices. The Company's products are used by surgeons and gastroenterologists in a variety of settings to provide interventional therapy to patients who suffer from obesity and the many co-morbidities associated with obesity as well as to treat various other gastrointestinal conditions. The Company's core products include the OverStitch™ Endoscopic Suturing System, the Intragastric Balloon System (most often branded as Orbera®), which together comprise the Company's Endo-bariatric products and the Lap-Band® Adjustable Gastric Banding System ("Surgical" products). In the U.S., the Company also offers Orbera® Coach, a digital and remotely delivered aftercare program. The Company has sales offices in England, Australia, Italy and Brazil that oversee regional sales and distribution activities outside the U.S., a manufacturing facility in Costa Rica and a device analysis lab in California. All other activities are managed and operated from facilities in Austin, Texas.

Significant Accounting Policies

Significant Accounting Policies	9 Months Ended
	Sep. 30, 2018
Accounting Policies [Abstract]
Significant Accounting Policies	Significant Accounting Policies (a) Basis of Presentation The Company prepared its interim condensed consolidated financial statements in conformity with accounting principles generally accepted in the United States of America ("GAAP"). They do not include all of the information and footnotes required by GAAP for complete financial statements. The accompanying condensed consolidated financial statements include the Company's accounts and the accounts of its wholly-owned subsidiaries. The Company has eliminated all intercompany balances and transactions. The Company has made estimates and judgments affecting the amounts reported in its condensed consolidated financial statements and the accompanying notes. The actual results that the Company experiences may differ materially from the Company's estimates. The accounting estimates that require the Company's most significant, difficult and subjective judgments include revenue recognition, useful lives of intangible assets and long-lived assets, impairment of long-lived assets and goodwill, valuation of inventory, allowance for doubtful accounts, stock compensation, and deferred tax asset valuation. (b) Unaudited Interim Results In management's opinion, the unaudited financial information for the interim periods presented includes all adjustments necessary for a fair presentation of the results of operations, financial position, and cash flows. All adjustments are of a normal recurring nature unless otherwise disclosed. Revenues, expenses, assets and liabilities can vary during each quarter of the year. Therefore, the results and trends in these interim financial statements may not be the same as those for the full year. This interim information should be read in conjunction with the audited consolidated financial statements in our Annual Report on Form 10-K for the year ended December 31, 2017. (c) Revenue Recognition The Company's principal source of revenue is from the sale of its products. Revenue is recognized when control of the promised goods is transferred to our customers, in an amount that reflects the consideration we expect to be entitled to in an exchange for those goods. Generally, these conditions are met under the Company's agreements with most customers upon product shipment. This includes sales to distributors, who sell the products to their customers, take title to the products and assume all risks of ownership at the time of shipment. Our distributors are obligated to pay within specified terms regardless of when, if ever, they sell the products. Customers and distributors generally have the right to return or exchange products purchased from the Company for up to thirty days from the date of product shipment. At the end of each period, the Company determines the extent to which its revenues need to be reduced to account for expected returns and exchanges. Certain customers may receive volume rebates or discounts, which are accounted for as variable consideration. We estimate these amounts based on the expected amount to be provided to customers and reduce revenues recognized. We record deferred revenues when cash payments are received in advance of the transfer of goods. The Company accounts for taxes collected from customers and remitted to governmental authorities on a net basis. Accordingly, such amounts are excluded from revenues. Amounts billed to customers related to shipping and handling are included in revenues. Shipping and handling costs related to revenue producing activities are included in cost of sales. (d) Recent Accounting Pronouncements On January 1, 2018, the Company adopted the provisions of ASU 2014-09, Revenue from Contracts with Customers ("ASC 606"), which requires an entity to recognize revenue when it transfers control of promised goods or services to customers in an amount that reflects the consideration to which it expects to be entitled in exchange for those goods or services. The Company adopted this new standard using the modified retrospective method and applied this method only to contracts that were not completed as of January 1, 2018. Prior periods were not retrospectively adjusted. There was no material impact on the Company's financial statement upon adoption of the new revenue recognition standard. In February 2016, the FASB issued ASU 2016-02, Leases ("ASU 2016-02") which requires a lessee to recognize assets and liabilities for leases with a maximum possible term of more than 12 months. A lessee would recognize a liability to make lease payments (the lease liability) and a right-of-use asset representing its right to use the leased asset (the underlying asset) for the lease term which will require companies to recognize most leases on the balance sheet, thereby increasing reported assets and liabilities. ASU 2016-02 will be effective for the Company on January 1, 2019. Upon initial evaluation, the Company believes the key change upon adoption will be the balance sheet recognition. The income statement recognition of lease expense appears similar to the Company's current methodology. The Company is continuing to evaluate other potential impacts on the consolidated financial statements. In January 2017, the FASB issued ASU 2017-04, Intangibles - Goodwill and Other: Simplifying the Test for Goodwill Impairment

Concentrations

Concentrations	9 Months Ended
	Sep. 30, 2018
Risks and Uncertainties [Abstract]
Concentrations	ConcentrationsFinancial instruments that potentially subject the Company to a concentration of credit risk principally consist of cash, cash equivalents, restricted cash, and accounts receivable. At September 30, 2018, the Company's cash, cash equivalents and restricted cash are held in deposit accounts at three different banks totaling $29,454. The Company has not experienced any losses in such accounts, and management does not believe the Company is exposed to any significant credit risk. Management further believes that the concentration of credit risk in the Company's accounts receivable is substantially mitigated by the Company's evaluation process, relatively short collection terms, and the high level of creditworthiness of its customers. The Company continually evaluates the status of each of its customers, but generally requires no collateral.

Inventory

Inventory	9 Months Ended
	Sep. 30, 2018
Inventory Disclosure [Abstract]
Inventory	Inventory Inventory consists of the following as of: September 30, 2018 December 31, 2017 (unaudited) Raw materials $ 4,600 $ 4,937 Work in progress 517 493 Finished goods 9,773 10,947 Less inventory reserve (1,582) (2,034) Total inventory, net $ 13,308 $ 14,343 The Company recorded an inventory impairment charge of $106 and $367 for the three and nine months ended September 30, 2018, respectively. Finished goods included $341 of consigned inventory at September 30, 2018. In the nine months ended September 30, 2018, the Company disposed of $819 of expired product which was fully reserved.

Accrued Expenses

Accrued Expenses	9 Months Ended
	Sep. 30, 2018
Payables and Accruals [Abstract]
Accrued Expenses	Accrued Expenses Accrued expenses consist of the following as of: September 30, 2018 December 31, 2017 (unaudited) Accrued employee compensation and expenses $ 3,779 $ 4,243 Accrued professional service fees 2,109 522 Accrued returns and rebates 392 438 Accrued insurance and taxes 567 527 Other 1,787 1,770 Total accrued expenses $ 8,634 $ 7,500

Long-Term Debt

Long-Term Debt	9 Months Ended
	Sep. 30, 2018
Debt Disclosure [Abstract]
Long-Term Debt	Long-Term Debt Long-term debt consists of the following as of: September 30, 2018 December 31, 2017 (unaudited) Senior secured credit facility $ 29,500 $ 32,000 Payment-in-kind interest 2,302 2,223 Discount on long-term debt (322) (534) Deferred financing costs (452) (368) Long-term debt $ 31,028 $ 33,321 In July 2018, the Company entered into a waiver with its lender that increased the maximum debt-to-revenue ratio for the three months ended June 30, 2018 to 0.56 from 0.53, waived the existing default under such ratio and prepaid $1,500 of the principal amount outstanding under its February 2015 credit agreement, together with accrued interest and certain fees and expenses. In September 2018, the Company made an additional $1,000 voluntary principal payment to the lender, and in November 2018, received a waiver for non-compliance with its third quarter debt-to-revenue ratio requirement in connection with the Seventh Amendment to the Credit Agreement and Waiver (see Note 13).

Stock Based Compensation

Stock Based Compensation	9 Months Ended
	Sep. 30, 2018
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Stock Based Compensation	Stock Based Compensation In June 2017, the 2017 Equity Incentive Plan (the "2017 Plan") was approved by the Company's stockholders and replaced the Company's 2016 Equity Incentive Plan (the "2016 Plan"), which was the successor to the 2006 Stock Option Plan (the "2006 Plan")(collectively with the 2016 Plan, the "Prior Plans"). Grants will no longer be made under the Prior Plans, but the awards that remain outstanding will continue to be governed by the terms of the applicable Prior Plan and the applicable award agreement. A summary of the stock option activity under the Company's 2017 Plan and Prior Plans (collectively, the "Equity Plans") as of September 30, 2018 is presented below. Options Weighted Average Exercise Price Weighted Average Remaining Contractual Term Aggregate Intrinsic Value Options outstanding, December 31, 2017 1,390,428 $4.64 7.0 years $2,432 Options granted 681,403 $6.72 Options exercised (275,805) $2.68 Options forfeited (76,960) $5.43 Options vested and expected to vest, September 30, 2018 1,719,066 $5.74 8.2 years $3,147 Options exercisable 645,796 $4.42 6.6 years $2,053 Shares subject to awards granted under the 2017 Plan which expire, are repurchased, or are canceled or forfeited will again become available for issuance under the 2017 Plan. The shares available will not be reduced by awards settled in cash or by shares withheld to satisfy tax withholding obligations. Only the net number of shares issued upon the exercise of options by means of a net exercise will be deducted from the shares available under the 2017 Plan. The fair value of stock option grants has been estimated at the date of grant using the Black-Scholes option pricing model with the following weighted average assumptions: Nine Months Ended September 30, 2018 Nine Months Ended September 30, 2017 Risk free interest rate 2.7 % 1.9 % Expected dividend yield — % — % Estimated volatility 63.3 % 65.1 % Expected life 5.8 years 5.5 years Additional information regarding options is as follows: Nine Months Ended September 30, 2018 Nine Months Ended September 30, 2017 Weighted-average grant date fair value of options granted during the period $ 3.95 $ 4.76 Aggregate intrinsic value of options exercised during the period $ 923 $ 249 The total compensation cost recognized for stock-based awards was $374 and $1,049 for the three and nine months ended September 30, 2018 and $211 and $538 for the three and nine months ended September 30, 2017. The aggregate intrinsic value in the table above represents the total pre-tax value of the options shown, calculated as the difference between the Company’s closing stock price on September 30, 2018 and the exercise prices of the options shown, multiplied by the number of in-the money options. This is the aggregate amount that would have been received by the option holders if they had all exercised their options on September 30, 2018 and sold the shares thereby received at the closing price of the Company’s stock on that date. This amount changes based on the closing price of the Company’s stock. The Company has 229,000 options outstanding to purchase common shares that vest upon the achievement of certain revenue targets for calendar year 2018. Achievement of the performance targets deemed probable are included in total stock compensation expense. Unrecognized compensation expense related to unvested options was approximately $3,012 at September 30, 2018, with a remaining amortization period of 2.9 years. A summary of the restricted stock unit activity under the Company's Equity Plans as of September 30, 2018 is presented below. Units Weighted Average Grant Date Fair Value Aggregate Intrinsic Value Unvested units, December 31, 2017 61,198 $5.60 $343 Restricted stock units granted 61,220 $6.63 Restricted stock units vested (17,070) $6.13 Restricted stock units forfeited (4,117) $6.53 Unvested units, September 30, 2018 101,231 $6.09 $726 Unrecognized compensation expense related to unvested restricted stock units was approximately $498 at September 30, 2018, with a remaining amortization period of 2.9 years.

Income Taxes

Income Taxes	9 Months Ended
	Sep. 30, 2018
Income Tax Disclosure [Abstract]
Income Taxes	Income Taxes The provision for income taxes for the three and nine months ended September 30, 2018 and 2017 includes both domestic and foreign income taxes at applicable statutory rates. The provision primarily consists of foreign income taxes. The Company has established a valuation allowance equal to the total net domestic deferred tax asset due to uncertainties regarding the realization of deferred tax assets based on the Company's lack of earnings history. As of September 30, 2018, the Company has no unrecognized tax benefits or accrued interest or penalties associated with uncertain tax positions. As of September 30, 2018, the Company has not completed its accounting for the tax effects of the Tax Cut and Jobs Act but has made reasonable estimates of the effects on the remeasurement of its gross presentation of deferred tax assets and liabilities as well as its transition tax liability. The Company will continue to make and refine its calculations as additional analysis is completed but expects no change in its net domestic deferred tax asset, which is currently $0. No revisions were recorded during the nine months ended September 30, 2018.

Net Loss Per Share

Net Loss Per Share	9 Months Ended
	Sep. 30, 2018
Earnings Per Share [Abstract]
Net Loss Per Share	Net Loss Per Share The basic and diluted net loss per common share presented in the condensed consolidated statements of operations and comprehensive loss is calculated by dividing net loss attributable to common stockholders by the weighted-average number of common shares outstanding during the period, without consideration for common stock equivalents. Potentially dilutive shares, which include warrants for the purchase of common stock, restricted stock units, and options outstanding under the Company's equity incentive plans, are considered to be common stock equivalents and are only included in the calculation of diluted net loss per share when their effect is dilutive. Potentially dilutive securities that are not included in the calculation of diluted net loss per share attributable to common stockholders because to do so would be anti-dilutive are as follows (in common stock equivalent shares on a weighted-average basis): Three Months Ended September 30, Nine Months Ended September 30, 2018 2017 2018 2017 Warrants for common stock 251,189 251,934 251,189 254,902 Common stock options 1,665,456 1,547,354 1,515,487 1,539,562 Restricted stock units 100,104 39,348 86,849 27,826 2,016,749 1,838,636 1,853,525 1,822,290

Liquidity and Capital Resources

Liquidity and Capital Resources	9 Months Ended
	Sep. 30, 2018
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Liquidity and Capital Resources	Liquidity and Capital Resources The Company has experienced operating losses since inception and occasional debt covenant violations and has an accumulated deficit of $204,455 as of September 30, 2018. To date, the Company has funded its operating losses and acquisitions through equity offerings and the issuance of debt instruments. The Company's ability to fund future operations will depend upon its level of future operating cash flow and its ability to access additional funding through either equity offerings, issuances of debt instruments or both. In December 2017, the Company filed a shelf registration statement on Form S-3 with the Securities and Exchange Commission ("SEC"), which permits the offering, issuance and sale by it of up to $50,000 of its common stock. In December 2017, the Company also entered into a sales agreement with Cantor Fitzgerald & Co. for the sale and issuance of shares of its common stock of up to $16,000 from time to time in an "at-the-market" program. The "at-the-market" program was terminated in June 2018 following the public offering of common stock described below, although the sales agreement remains in effect. In June 2018, the Company entered into an underwriting agreement with Craig-Hallum Capital Group LLC and completed a public offering of 4,309,090 shares of common stock at a price of $5.50 per share, including 562,055 shares issued upon the full exercise of the underwriter's option to purchase additional shares, resulting in net proceeds of $21,857, after deducting underwriting discounts and expenses. In February 2015, the Company entered into the credit agreement that, as subsequently amended, requires the Company to meet a debt to revenue ratio. If the Company is not able to meet its ongoing quarterly covenant requirements or utilize the remaining cure provision right, the repayment of this senior secured credit facility could be accelerated at the lender's discretion. For the quarter ended September 30, 2018, the Company did not achieve the maximum debt-to-revenue requirement and received a waiver from the lender for this noncompliance. The Company believes it has the ability, through repayment of outstanding debt to meet the required covenant for at least the next twelve months.

Fair Value Measurements

Fair Value Measurements	9 Months Ended
	Sep. 30, 2018
Fair Value Disclosures [Abstract]
Fair Value Measurements	Fair Value Measurements The carrying amounts of the Company's financial instruments, which primarily include cash, cash equivalents, and restricted cash, accounts receivable, accounts payable and accrued expenses, approximate their fair values due to their short maturities. The fair value of the Company's long-term debt is estimated by management to approximate $32,109 at September 30, 2018. Management's estimates are based on comparisons of the characteristics of the Company's obligations, comparable ranges of interest rates on recently issued debt, and maturity. Such valuation inputs are considered a Level 3 measurement in the fair value valuation hierarchy. The accounting guidance defines fair value, establishes a consistent framework for measuring fair value and expands disclosure for each major asset and liability category measured at fair value on either a recurring or nonrecurring basis. Fair value is defined as an exit price, representing the amount that would be received to sell an asset or paid to transfer a liability in an orderly transaction between market participants. As such, fair value is a market-based measurement that should be determined based on assumptions that market participants would use in pricing an asset or liability. As a basis for considering such assumptions, the accounting guidance establishes a three-tier fair value hierarchy, which prioritizes the inputs used in measuring fair value as follows: Level 1: Observable inputs such as quoted prices in active markets; Level 2: Inputs, other than the quoted prices in active markets, that are observable either directly or indirectly; and Level 3: Unobservable inputs in which there is little or no market data, which require the reporting entity to develop its own assumptions.

Segment and Geographic Informat

Segment and Geographic Information	9 Months Ended
	Sep. 30, 2018
Segment Reporting [Abstract]
Segment and Geographic Information	Segment and Geographic Information Operating segments are defined as components of an enterprise for which separate financial information is available and evaluated regularly by the chief operating decision maker, or decision-making group, in deciding how to allocate resources and in assessing performance. The Company globally manages the business within one reportable segment. Segment information is consistent with how management reviews the business, makes investing and resource allocation decisions and assesses operating performance. Product sales by product group and geographic market, based on the location of the customer, whether the U.S. or outside the U.S. ("OUS") for the periods shown were as follows: Three Months Ended September 30, 2018 Three Months Ended September 30, 2017 (unaudited) U.S. OUS Total Revenues % Total Revenues U.S. OUS Total Revenues % Total Revenues ESS $ 2,511 $ 2,698 $ 5,209 36.8 % $ 2,018 $ 2,878 $ 4,896 29.6 % IGB $ 1,175 $ 2,898 $ 4,073 28.8 % $ 1,263 $ 3,151 $ 4,414 26.7 % Endo-bariatric $ 3,686 $ 5,596 $ 9,282 65.6 % $ 3,281 $ 6,029 $ 9,310 56.3 % Surgical 2,790 1,851 4,641 32.9 % 4,422 2,605 7,027 42.5 % Other 210 8 218 1.5 % 200 7 207 1.2 % Total revenues $ 6,686 $ 7,455 $ 14,141 100.0 % $ 7,903 $ 8,641 $ 16,544 100.0 % % Total revenues 47.3 % 52.7 % 47.8 % 52.2 % Nine Months Ended September 30, 2018 Nine Months Ended September 30, 2017 (unaudited) U.S. OUS Total Revenues % Total Revenues U.S. OUS Total Revenues % Total Revenues ESS $ 7,663 $ 8,793 $ 16,456 36.0 % $ 5,740 $ 5,988 $ 11,728 24.3 % IGB $ 4,461 $ 9,425 $ 13,886 30.4 % $ 5,123 $ 9,312 $ 14,435 30.0 % Endo-bariatric $ 12,124 $ 18,218 $ 30,342 66.4 % $ 10,863 $ 15,300 $ 26,163 54.3 % Surgical 8,359 6,210 14,569 31.9 % 13,271 8,164 21,435 44.5 % Other 735 26 761 1.7 % 551 21 572 1.2 % Total revenues $ 21,218 $ 24,454 $ 45,672 100.0 % $ 24,685 $ 23,485 $ 48,170 100.0 % % Total revenues 46.5 % 53.5 % 51.2 % 48.8 % _________________________________________ Endoscopic Suturing System ("ESS") and Intragastric Balloon ("IGB"). Total distributor sales were 23.4% and 21.5% of total OUS revenues for the three months ended September 30, 2018 and 2017, respectively, and 21.8% and 23.3% for the nine months ended September 30, 2018 and 2017, respectively. Sales in the next largest individual country outside the U.S. were 7.2% and 10.0% of total revenues for the three months ended September 30, 2018 and 2017, respectively and 7.8% and 8.1% for the nine months ended September 30, 2018 and 2017, respectively. The following table represents property and equipment, net based on the physical geographic location of the asset: September 30, 2018 December 31, 2017 (unaudited) United States $ 2,935 $ 2,855 Costa Rica 3,503 3,748 Other 250 282 Total property and equipment, net $ 6,688 $ 6,885

Subsequent Event

Subsequent Event	9 Months Ended
	Sep. 30, 2018
Subsequent Events [Abstract]
Subsequent Event	Subsequent Event On November 6, 2018, the Company entered into a Seventh Amendment to the Credit Agreement and Waiver with its lender Athyrium Opportunities II Acquisition LP (“Athyrium”) which granted a waiver for the noncompliance of the debt-to-revenue ratio requirement for the three months ended September 30, 2018. In addition, the amendment removed the cure right provision with regards to the debt-to-revenue ratio requirement in future periods.

Significant Accounting Polici_2

Significant Accounting Policies (Policies)	9 Months Ended
	Sep. 30, 2018
Accounting Policies [Abstract]
Organization and Business Description	Apollo Endosurgery, Inc. is a Delaware corporation with both domestic and foreign wholly-owned subsidiaries. Throughout these Notes "Apollo" and the "Company" refer to Apollo Endosurgery, Inc. and its consolidated subsidiaries. Apollo is a medical technology company primarily focused on the design, development, and commercialization of innovative medical devices. The Company's products are used by surgeons and gastroenterologists in a variety of settings to provide interventional therapy to patients who suffer from obesity and the many co-morbidities associated with obesity as well as to treat various other gastrointestinal conditions. The Company's core products include the OverStitch™ Endoscopic Suturing System, the Intragastric Balloon System (most often branded as Orbera®), which together comprise the Company's Endo-bariatric products and the Lap-Band® Adjustable Gastric Banding System ("Surgical" products). In the U.S., the Company also offers Orbera® Coach, a digital and remotely delivered aftercare program.
Revenue Recognition	Revenue Recognition The Company's principal source of revenue is from the sale of its products. Revenue is recognized when control of the promised goods is transferred to our customers, in an amount that reflects the consideration we expect to be entitled to in an exchange for those goods. Generally, these conditions are met under the Company's agreements with most customers upon product shipment. This includes sales to distributors, who sell the products to their customers, take title to the products and assume all risks of ownership at the time of shipment. Our distributors are obligated to pay within specified terms regardless of when, if ever, they sell the products. Customers and distributors generally have the right to return or exchange products purchased from the Company for up to thirty days from the date of product shipment. At the end of each period, the Company determines the extent to which its revenues need to be reduced to account for expected returns and exchanges. Certain customers may receive volume rebates or discounts, which are accounted for as variable consideration. We estimate these amounts based on the expected amount to be provided to customers and reduce revenues recognized. We record deferred revenues when cash payments are received in advance of the transfer of goods. The Company accounts for taxes collected from customers and remitted to governmental authorities on a net basis. Accordingly, such amounts are excluded from revenues. Amounts billed to customers related to shipping and handling are included in revenues. Shipping and handling costs related to revenue producing activities are included in cost of sales.
Recent Accounting Pronouncements	Recent Accounting Pronouncements On January 1, 2018, the Company adopted the provisions of ASU 2014-09, Revenue from Contracts with Customers ("ASC 606"), which requires an entity to recognize revenue when it transfers control of promised goods or services to customers in an amount that reflects the consideration to which it expects to be entitled in exchange for those goods or services. The Company adopted this new standard using the modified retrospective method and applied this method only to contracts that were not completed as of January 1, 2018. Prior periods were not retrospectively adjusted. There was no material impact on the Company's financial statement upon adoption of the new revenue recognition standard. In February 2016, the FASB issued ASU 2016-02, Leases ("ASU 2016-02") which requires a lessee to recognize assets and liabilities for leases with a maximum possible term of more than 12 months. A lessee would recognize a liability to make lease payments (the lease liability) and a right-of-use asset representing its right to use the leased asset (the underlying asset) for the lease term which will require companies to recognize most leases on the balance sheet, thereby increasing reported assets and liabilities. ASU 2016-02 will be effective for the Company on January 1, 2019. Upon initial evaluation, the Company believes the key change upon adoption will be the balance sheet recognition. The income statement recognition of lease expense appears similar to the Company's current methodology. The Company is continuing to evaluate other potential impacts on the consolidated financial statements. In January 2017, the FASB issued ASU 2017-04, Intangibles - Goodwill and Other: Simplifying the Test for Goodwill Impairment
Net Loss Per Share	The basic and diluted net loss per common share presented in the condensed consolidated statements of operations and comprehensive loss is calculated by dividing net loss attributable to common stockholders by the weighted-average number of common shares outstanding during the period, without consideration for common stock equivalents. Potentially dilutive shares, which include warrants for the purchase of common stock, restricted stock units, and options outstanding under the Company's equity incentive plans, are considered to be common stock equivalents and are only included in the calculation of diluted net loss per share when their effect is dilutive.

Inventory (Tables)

Inventory (Tables)	9 Months Ended
	Sep. 30, 2018
Inventory Disclosure [Abstract]
Schedule of Inventory	Inventory consists of the following as of: September 30, 2018 December 31, 2017 (unaudited) Raw materials $ 4,600 $ 4,937 Work in progress 517 493 Finished goods 9,773 10,947 Less inventory reserve (1,582) (2,034) Total inventory, net $ 13,308 $ 14,343

Accrued Expenses (Tables)

Accrued Expenses (Tables)	9 Months Ended
	Sep. 30, 2018
Payables and Accruals [Abstract]
Schedule of Accrued Expenses	Accrued expenses consist of the following as of: September 30, 2018 December 31, 2017 (unaudited) Accrued employee compensation and expenses $ 3,779 $ 4,243 Accrued professional service fees 2,109 522 Accrued returns and rebates 392 438 Accrued insurance and taxes 567 527 Other 1,787 1,770 Total accrued expenses $ 8,634 $ 7,500

Long-Term Debt (Tables)

Long-Term Debt (Tables)	9 Months Ended
	Sep. 30, 2018
Debt Disclosure [Abstract]
Schedule of Long-term Debt	Long-term debt consists of the following as of: September 30, 2018 December 31, 2017 (unaudited) Senior secured credit facility $ 29,500 $ 32,000 Payment-in-kind interest 2,302 2,223 Discount on long-term debt (322) (534) Deferred financing costs (452) (368) Long-term debt $ 31,028 $ 33,321

Stock Based Compensation (Table

Stock Based Compensation (Tables)	9 Months Ended
	Sep. 30, 2018
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Schedule of Stock Option Activity	A summary of the stock option activity under the Company's 2017 Plan and Prior Plans (collectively, the "Equity Plans") as of September 30, 2018 is presented below. Options Weighted Average Exercise Price Weighted Average Remaining Contractual Term Aggregate Intrinsic Value Options outstanding, December 31, 2017 1,390,428 $4.64 7.0 years $2,432 Options granted 681,403 $6.72 Options exercised (275,805) $2.68 Options forfeited (76,960) $5.43 Options vested and expected to vest, September 30, 2018 1,719,066 $5.74 8.2 years $3,147 Options exercisable 645,796 $4.42 6.6 years $2,053
Schedule of Fair Value of Stock Options	The fair value of stock option grants has been estimated at the date of grant using the Black-Scholes option pricing model with the following weighted average assumptions: Nine Months Ended September 30, 2018 Nine Months Ended September 30, 2017 Risk free interest rate 2.7 % 1.9 % Expected dividend yield — % — % Estimated volatility 63.3 % 65.1 % Expected life 5.8 years 5.5 years
Schedule of Other Stock Option Information	Additional information regarding options is as follows: Nine Months Ended September 30, 2018 Nine Months Ended September 30, 2017 Weighted-average grant date fair value of options granted during the period $ 3.95 $ 4.76 Aggregate intrinsic value of options exercised during the period $ 923 $ 249
Schedule of Restricted Stock Unit Activity	A summary of the restricted stock unit activity under the Company's Equity Plans as of September 30, 2018 is presented below. Units Weighted Average Grant Date Fair Value Aggregate Intrinsic Value Unvested units, December 31, 2017 61,198 $5.60 $343 Restricted stock units granted 61,220 $6.63 Restricted stock units vested (17,070) $6.13 Restricted stock units forfeited (4,117) $6.53 Unvested units, September 30, 2018 101,231 $6.09 $726

Net Loss Per Share (Tables)

Net Loss Per Share (Tables)	9 Months Ended
	Sep. 30, 2018
Earnings Per Share [Abstract]
Schedule of Antidilutive Securities Excluded from Computation of Diluted Loss Per Share	Potentially dilutive securities that are not included in the calculation of diluted net loss per share attributable to common stockholders because to do so would be anti-dilutive are as follows (in common stock equivalent shares on a weighted-average basis): Three Months Ended September 30, Nine Months Ended September 30, 2018 2017 2018 2017 Warrants for common stock 251,189 251,934 251,189 254,902 Common stock options 1,665,456 1,547,354 1,515,487 1,539,562 Restricted stock units 100,104 39,348 86,849 27,826 2,016,749 1,838,636 1,853,525 1,822,290

Segment and Geographic Inform_2

Segment and Geographic Information (Tables)	9 Months Ended
	Sep. 30, 2018
Segment Reporting [Abstract]
Schedule of Product Sales by Product Group and Geographic Market	Product sales by product group and geographic market, based on the location of the customer, whether the U.S. or outside the U.S. ("OUS") for the periods shown were as follows: Three Months Ended September 30, 2018 Three Months Ended September 30, 2017 (unaudited) U.S. OUS Total Revenues % Total Revenues U.S. OUS Total Revenues % Total Revenues ESS $ 2,511 $ 2,698 $ 5,209 36.8 % $ 2,018 $ 2,878 $ 4,896 29.6 % IGB $ 1,175 $ 2,898 $ 4,073 28.8 % $ 1,263 $ 3,151 $ 4,414 26.7 % Endo-bariatric $ 3,686 $ 5,596 $ 9,282 65.6 % $ 3,281 $ 6,029 $ 9,310 56.3 % Surgical 2,790 1,851 4,641 32.9 % 4,422 2,605 7,027 42.5 % Other 210 8 218 1.5 % 200 7 207 1.2 % Total revenues $ 6,686 $ 7,455 $ 14,141 100.0 % $ 7,903 $ 8,641 $ 16,544 100.0 % % Total revenues 47.3 % 52.7 % 47.8 % 52.2 % Nine Months Ended September 30, 2018 Nine Months Ended September 30, 2017 (unaudited) U.S. OUS Total Revenues % Total Revenues U.S. OUS Total Revenues % Total Revenues ESS $ 7,663 $ 8,793 $ 16,456 36.0 % $ 5,740 $ 5,988 $ 11,728 24.3 % IGB $ 4,461 $ 9,425 $ 13,886 30.4 % $ 5,123 $ 9,312 $ 14,435 30.0 % Endo-bariatric $ 12,124 $ 18,218 $ 30,342 66.4 % $ 10,863 $ 15,300 $ 26,163 54.3 % Surgical 8,359 6,210 14,569 31.9 % 13,271 8,164 21,435 44.5 % Other 735 26 761 1.7 % 551 21 572 1.2 % Total revenues $ 21,218 $ 24,454 $ 45,672 100.0 % $ 24,685 $ 23,485 $ 48,170 100.0 % % Total revenues 46.5 % 53.5 % 51.2 % 48.8 % _________________________________________ Endoscopic Suturing System ("ESS") and Intragastric Balloon ("IGB").
Schedule of Long-Lived Assets by Geographic Area	The following table represents property and equipment, net based on the physical geographic location of the asset: September 30, 2018 December 31, 2017 (unaudited) United States $ 2,935 $ 2,855 Costa Rica 3,503 3,748 Other 250 282 Total property and equipment, net $ 6,688 $ 6,885

Concentrations (Details)

Concentrations (Details) $ in Thousands	Sep. 30, 2018USD ($)bank	Dec. 31, 2017USD ($)	Sep. 30, 2017USD ($)	Dec. 31, 2016USD ($)
Risks and Uncertainties [Abstract]
Number of banks | bank	3
Cash and cash equivalents and restricted cash | $	$ 29,454	$ 31,418	$ 35,499	$ 20,041

Inventory (Details)

Inventory (Details) - USD ($) $ in Thousands	3 Months Ended	9 Months Ended
	Sep. 30, 2018	Sep. 30, 2018	Sep. 30, 2017	Dec. 31, 2017
Inventory Disclosure [Abstract]
Raw materials	$ 4,600	$ 4,600		$ 4,937
Work in progress	517	517		493
Finished goods	9,773	9,773		10,947
Less inventory reserve	(1,582)	(1,582)		(2,034)
Total inventory, net	13,308	13,308		$ 14,343
Change in inventory reserve	106	367	$ 199
Consigned inventory	$ 341	341
Expired product		$ 819

Accrued Expenses (Details)

Accrued Expenses (Details) - USD ($) $ in Thousands	Sep. 30, 2018	Dec. 31, 2017
Payables and Accruals [Abstract]
Accrued employee compensation and expenses	$ 3,779	$ 4,243
Accrued professional service fees	2,109	522
Accrued returns and rebates	392	438
Accrued insurance and taxes	567	527
Other	1,787	1,770
Total accrued expenses	$ 8,634	$ 7,500

Long-Term Debt (Schedule of Lon

Long-Term Debt (Schedule of Long-term Debt) (Details) - USD ($) $ in Thousands	Sep. 30, 2018	Dec. 31, 2017
Debt Instrument [Line Items]
Discount on long-term debt	$ (322)	$ (534)
Deferred financing costs	(452)	(368)
Long-term debt	31,028	33,321
Payment in Kind Interest [Member]
Debt Instrument [Line Items]
Long-term debt	2,302	2,223
Line of Credit [Member] | Secured Debt [Member] | Credit Facility [Member]
Debt Instrument [Line Items]
Long-term debt	$ 29,500	$ 32,000

Long-Term Debt (Narrative) (Det

Long-Term Debt (Narrative) (Details) - Secured Debt [Member] - Line of Credit [Member] - Waiver Agreement [Member]	1 Months Ended		3 Months Ended
	Sep. 30, 2018USD ($)	Jul. 31, 2018USD ($)	Sep. 30, 2018
Debt Instrument [Line Items]
Minimum debt to revenue ratio		0.56	0.53
Repayments of debt		$ 1,500,000
Principal payment	$ 1,000,000

Stock Based Compensation (Stock

Stock Based Compensation (Stock Option Activity) (Details) - Stock Option [Member] - USD ($) $ / shares in Units, $ in Thousands	9 Months Ended	12 Months Ended
	Sep. 30, 2018	Dec. 31, 2017
Options
Options outstanding, beginning balance (in shares)		1,390,428
Options granted (in shares)	681,403
Options exercised (in shares)	(275,805)
Options forfeited (in shares)	(76,960)
Options vested and expected to vest (in shares)	1,719,066
Options exercisable (in shares)	645,796
Weighted Average Exercise Price
Weighted average exercise price, beginning balance (in USD per share)		$ 4.64
Options granted (in USD per share)	$ 6.72
Options exercised (in USD per share)	2.68
Options forfeited (in USD per share)	5.43
Options vested and expected to vest (in USD per share)	5.74
Options exercisable (in USD per share)	$ 4.42
Weighted Average Remaining Contractual Term
Weighted Average Remaining Contractual Term		7 years
Options vested and expected to vest	8 years 2 months 12 days
Options exercisable	6 years 7 months 6 days
Aggregate Intrinsic Value
Aggregate intrinsic value		$ 2,432
Options vested and expected to vest	$ 3,147
Options exercisable	$ 2,053

Stock Based Compensation (Fair

Stock Based Compensation (Fair Value of Stock Options) (Details) - Stock Option [Member]	9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Risk free interest rate	2.70%	1.90%
Expected dividend yield	0.00%	0.00%
Estimated volatility	63.30%	65.10%
Expected life	5 years 9 months 18 days	5 years 6 months

Stock Based Compensation (Addit

Stock Based Compensation (Additional Information) (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017	Dec. 31, 2017
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock compensation cost	$ 374	$ 211	$ 1,049	$ 538
Unrecognized compensation expense related to unvested options	$ 3,012		$ 3,012
Remaining amortization period			2 years 10 months 24 days
Stock Option [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Weighted-average grant date fair value of options granted during the period (in USD per share)			$ 3.95	$ 4.76
Aggregate intrinsic value of options exercised during the period			$ 923	$ 249
Options granted in period (in shares)					1,390,428
Performance Shares [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Options granted in period (in shares)	229,000		229,000
Restricted stock units [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Remaining amortization period			2 years 10 months 24 days
Unrecognized compensation expense related to unvested restricted stock units	$ 498		$ 498

Stock Based Compensation (Restr

Stock Based Compensation (Restricted Stock Units Activity) (Details) - Restricted stock units [Member] - USD ($) $ / shares in Units, $ in Thousands	9 Months Ended
	Sep. 30, 2018	Dec. 31, 2017
Number of Units
Unvested Units (shares)	61,198
Restricted stock units granted (shares)	61,220
Restricted stock units vested (shares)	(17,070)
Restricted stock units forfeited (shares)	(4,117)
Unvested Units (shares)	101,231
Weighted-Average Grant Date Fair Value
Unvested Units (USD per share)	$ 5.60
Restricted stock units granted (USD per share)	6.63
Restricted stock units vested (USD per share)	6.13
Restricted stock units forfeited (USD per share)	6.53
Unvested Units (USD per share)	$ 6.09
Aggregate Intrinsic Value
Aggregate Intrinsic Value	$ 726	$ 343

Income Taxes (Details)

Income Taxes (Details)	Sep. 30, 2018USD ($)
Income Tax Disclosure [Abstract]
Unrecognized tax benefits	$ 0
Accrued interest	0
Tax penalties	0
Deferred tax assets	$ 0

Net Loss Per Share (Details)

Net Loss Per Share (Details) - shares	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of diluted loss per share	2,016,749	1,838,636	1,853,525	1,822,290
Warrants for common [Member]
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of diluted loss per share	251,189	251,934	251,189	254,902
Common stock options [Member]
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of diluted loss per share	1,665,456	1,547,354	1,515,487	1,539,562
Restricted stock units [Member]
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of diluted loss per share	100,104	39,348	86,849	27,826

Liquidity and Capital Resourc_2

Liquidity and Capital Resources (Details) - USD ($) $ / shares in Units, $ in Thousands	1 Months Ended		9 Months Ended
	Jun. 30, 2018	Dec. 31, 2017	Sep. 30, 2018	Sep. 30, 2017
Subsidiary, Sale of Stock [Line Items]
Accumulated deficit		$ 177,021	$ 204,455
Sale of stock, number of shares (shares)	4,309,090
Sale of stock, price per share (in USD per share)			$ 5.50
Proceeds from the issuance of common stock			$ 21,857	$ 33,584
Shelf registration [Member]
Subsidiary, Sale of Stock [Line Items]
Authorized amount		16,000
Shelf registration [Member] | Common Stock [Member]
Subsidiary, Sale of Stock [Line Items]
Authorized amount		$ 50,000
Underwriters [Member]
Subsidiary, Sale of Stock [Line Items]
Sale of stock, number of shares (shares)	562,055

Fair Value Measurements (Detail

Fair Value Measurements (Details) $ in Thousands	Sep. 30, 2018USD ($)
Fair Value Disclosures [Abstract]
Fair value of long-term debt	$ 32,109

Segment and Geographic Inform_3

Segment and Geographic Information (Segment Information) (Details) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2018USD ($)	Sep. 30, 2017USD ($)	Sep. 30, 2018USD ($)segment	Sep. 30, 2017USD ($)
Segment Reporting [Abstract]
Number of reportable segments | segment			1
Revenue, Major Customer [Line Items]
Revenues	$ 14,141	$ 16,544	$ 45,672	$ 48,170
Segment Revenue [Member] | Product Risk [Member]
Revenue, Major Customer [Line Items]
Percentage of revenue or sales	100.00%	100.00%	100.00%	100.00%
United States [Member]
Revenue, Major Customer [Line Items]
Revenues	$ 6,686	$ 7,903	$ 21,218	$ 24,685
United States [Member] | Segment Revenue [Member] | Product Risk [Member]
Revenue, Major Customer [Line Items]
Percentage of revenue or sales	47.30%	47.80%	46.50%	51.20%
OUS [Member]
Revenue, Major Customer [Line Items]
Revenues	$ 7,455	$ 8,641	$ 24,454	$ 23,485
OUS [Member] | Segment Revenue [Member] | Product Risk [Member]
Revenue, Major Customer [Line Items]
Percentage of revenue or sales	52.70%	52.20%	53.50%	48.80%
OUS [Member] | Distributor Sales [Member] | Product Risk [Member]
Revenue, Major Customer [Line Items]
Percentage of revenue or sales	23.40%	21.50%	21.80%	23.30%
Non-US, Next Largest Single Country [Member] | Distributor Sales [Member] | Product Risk [Member]
Revenue, Major Customer [Line Items]
Percentage of revenue or sales	7.20%	10.00%	7.80%	8.10%
ESS [Member]
Revenue, Major Customer [Line Items]
Revenues	$ 5,209	$ 4,896	$ 16,456
ESS [Member] | Segment Revenue [Member] | Product Risk [Member]
Revenue, Major Customer [Line Items]
Percentage of revenue or sales	36.80%	29.60%	36.00%
ESS [Member] | United States [Member]
Revenue, Major Customer [Line Items]
Revenues	$ 2,511	$ 2,018	$ 7,663	$ 5,740
ESS [Member] | OUS [Member]
Revenue, Major Customer [Line Items]
Revenues	2,698	2,878	8,793	5,988
IGB [Member]
Revenue, Major Customer [Line Items]
Revenues	$ 4,073	$ 4,414	$ 13,886
IGB [Member] | Segment Revenue [Member] | Product Risk [Member]
Revenue, Major Customer [Line Items]
Percentage of revenue or sales	28.80%	26.70%	30.40%
IGB [Member] | United States [Member]
Revenue, Major Customer [Line Items]
Revenues	$ 1,175	$ 1,263	$ 4,461	5,123
IGB [Member] | OUS [Member]
Revenue, Major Customer [Line Items]
Revenues	2,898	3,151	9,425	9,312
Endo-bariatric [Member]
Revenue, Major Customer [Line Items]
Revenues	$ 9,282	$ 9,310	$ 30,342	$ 26,163
Endo-bariatric [Member] | Segment Revenue [Member] | Product Risk [Member]
Revenue, Major Customer [Line Items]
Percentage of revenue or sales	65.60%	56.30%	66.40%	54.30%
Endo-bariatric [Member] | United States [Member]
Revenue, Major Customer [Line Items]
Revenues	$ 3,686	$ 3,281	$ 12,124	$ 10,863
Endo-bariatric [Member] | OUS [Member]
Revenue, Major Customer [Line Items]
Revenues	5,596	6,029	18,218	15,300
Surgical [Member]
Revenue, Major Customer [Line Items]
Revenues	$ 4,641	$ 7,027	$ 14,569	$ 21,435
Surgical [Member] | Segment Revenue [Member] | Product Risk [Member]
Revenue, Major Customer [Line Items]
Percentage of revenue or sales	32.90%	42.50%	31.90%	44.50%
Surgical [Member] | United States [Member]
Revenue, Major Customer [Line Items]
Revenues	$ 2,790	$ 4,422	$ 8,359	$ 13,271
Surgical [Member] | OUS [Member]
Revenue, Major Customer [Line Items]
Revenues	1,851	2,605	6,210	8,164
Other [Member]
Revenue, Major Customer [Line Items]
Revenues	$ 218	$ 207	$ 761	$ 572
Other [Member] | Segment Revenue [Member] | Product Risk [Member]
Revenue, Major Customer [Line Items]
Percentage of revenue or sales	1.50%	1.20%	1.70%	1.20%
Other [Member] | United States [Member]
Revenue, Major Customer [Line Items]
Revenues	$ 210	$ 200	$ 735	$ 551
Other [Member] | OUS [Member]
Revenue, Major Customer [Line Items]
Revenues	$ 8	$ 7	$ 26	$ 21

Segment and Geographic Inform_4

Segment and Geographic Information (Long-Lived Assets by Geographic Area) (Details) - USD ($) $ in Thousands	Sep. 30, 2018	Dec. 31, 2017
Revenues from External Customers and Long-Lived Assets [Line Items]
Total property and equipment, net	$ 6,688	$ 6,885
United States [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Total property and equipment, net	2,935	2,855
Costa Rica [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Total property and equipment, net	3,503	3,748
Other [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Total property and equipment, net	$ 250	$ 282