Apollo Endosurgery (APEN) 10-Q 4 May 20 2020 Q1 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	3 Months Ended
	Mar. 31, 2020	Apr. 24, 2020
Cover [Abstract]
Document Type	10-Q
Document Period End Date	Mar. 31, 2020
Document Quarterly Report	true
Document Transition Report	false
Entity File Number	001-35706
Entity Registrant Name	APOLLO ENDOSURGERY, INC.
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	16-1630142
Entity Address, Address Line One	1120 S. Capital of Texas Highway
Entity Address, Address Line Two	Building 1, Suite #300
Entity Address, City or Town	Austin
Entity Address, State or Province	TX
Entity Address, Postal Zip Code	78746
City Area Code	512
Local Phone Number	279-5100
Title of 12(b) Security	Common stock, par value $0.001 per share
Trading Symbol	APEN
Security Exchange Name	NASDAQ
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Non-accelerated Filer
Entity Small Business	true
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		21,128,101
Entity Central Index Key	0001251769
Current Fiscal Year End Date	--12-31
Amendment Flag	false
Document Fiscal Year Focus	2020
Document Fiscal Period Focus	Q1

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Current assets:
Cash and cash equivalents	$ 23,206	$ 29,905
Accounts receivable, net of allowance for doubtful accounts of $619 and $658, respectively	7,524	9,232
Inventory, net	10,245	8,865
Prepaid expenses and other current assets	3,117	2,998
Total current assets	44,092	51,000
Restricted cash	833	1,016
Property, equipment and right-of-use assets	6,206	6,612
Goodwill	5,290	5,290
Intangible assets, net of accumulated amortization of $12,093 and $11,648, respectively	7,377	7,831
Other assets	2,899	2,833
Total assets	66,697	74,582
Current liabilities:
Accounts payable	9,528	9,902
Accrued expenses	8,613	8,438
Current portion of long-term debt	34,481	34,449
Total current liabilities	52,622	52,789
Convertible debt	18,632	18,554
Long-term liabilities	896	1,116
Total liabilities	72,150	72,459
Commitments and contingencies
Stockholders' (deficit) equity:
Common stock; $0.001 par value; 100,000,000 shares authorized; 21,128,101 and 20,951,963 shares issued and outstanding at March 31, 2020 and December 31, 2019, respectively	21	21
Additional paid-in capital	251,502	250,634
Accumulated other comprehensive income	3,442	1,630
Accumulated deficit	(260,418)	(250,162)
Total stockholders' (deficit) equity	(5,453)	2,123
Total liabilities and stockholders' (deficit) equity	$ 66,697	$ 74,582

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Statement of Financial Position [Abstract]
Allowance for doubtful accounts	$ 619	$ 658
Accumulated amortization	$ 12,093	$ 11,648
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)	21,128,101	20,951,963
Common stock, shares outstanding (shares)	21,128,101	20,951,963

Condensed Consolidated Statemen

Condensed Consolidated Statements of Operations and Comprehensive Loss - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Income Statement [Abstract]
Revenues	$ 10,718	$ 13,211
Cost of sales	5,081	5,970
Gross margin	5,637	7,241
Operating expenses:
Sales and marketing	6,330	7,697
General and administrative	3,339	3,717
Research and development	2,147	3,428
Amortization of intangible assets	496	553
Settlement gain	0	(5,609)
Total operating expenses	12,312	9,786
Loss from operations	(6,675)	(2,545)
Other expenses:
Interest expense, net	1,244	959
Other expense (income), net	2,294	(751)
Net loss before income taxes	(10,213)	(2,753)
Income tax expense	43	51
Net loss	(10,256)	(2,804)
Other comprehensive income (loss):
Foreign currency translation	1,812	(888)
Comprehensive loss	$ (8,444)	$ (3,692)
Net loss per share, basic and diluted (USD per share)	$ (0.49)	$ (0.13)
Shares used in computing net loss per share, basic and diluted (shares)	21,117,126	21,907,281

Condensed Consolidated Statem_2

Condensed Consolidated Statements of Changes in Stockholders’ Equity - USD ($) $ in Thousands	Total	Common Stock	Additional Paid-in Capital	Accumulated Other Comprehensive Income	Accumulated Deficit
Beginning balance, shares at Dec. 31, 2018		21,899,522
Beginning balance at Dec. 31, 2018	$ 28,908	$ 22	$ 249,115	$ 2,501	$ (222,730)
Exercise of common stock options, shares		1,573
Exercise of common stock options	3		3
Issuance of restricted stock units, shares		21,249
Stock based compensation	323		323
Foreign currency translation	(888)			(888)
Net loss	(2,804)				(2,804)
Ending balance, shares at Mar. 31, 2019		21,922,344
Ending balance at Mar. 31, 2019	$ 25,542	$ 22	249,441	1,613	(225,534)
Beginning balance, shares at Dec. 31, 2019	20,951,963	20,951,963
Beginning balance at Dec. 31, 2019	$ 2,123	$ 21	250,634	1,630	(250,162)
Issuance of restricted stock units, shares		11,341
Issuance of common stock for Convertible Debt interest, shares		164,797
Issuance of common stock for Convertible Debt interest	467		467
Stock based compensation	401		401
Foreign currency translation	1,812			1,812
Net loss	$ (10,256)				(10,256)
Ending balance, shares at Mar. 31, 2020	21,128,101	21,128,101
Ending balance at Mar. 31, 2020	$ (5,453)	$ 21	$ 251,502	$ 3,442	$ (260,418)

Condensed Consolidated Statem_3

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Cash flows from operating activities:
Net loss	$ (10,256)	$ (2,804)
Adjustments to reconcile net loss to net cash used in operating activities:
Depreciation and amortization	955	1,104
Amortization of deferred financing costs	154	298
Non-cash interest	356	3
Provision for doubtful accounts receivable	77	(37)
Inventory impairment	0	40
Stock based compensation	401	323
Unrealized foreign exchange on intercompany payables	2,240	(936)
Settlement gain	0	(5,609)
Changes in operating assets and liabilities:
Accounts receivable	1,430	790
Inventory	(1,522)	(502)
Prepaid expenses and other assets	(113)	(350)
Accounts payable and accrued expenses	15	1,618
Net cash used in operating activities	(6,263)	(6,062)
Cash flows from investing activities:
Purchases of property and equipment	(272)	(112)
Purchases of intangibles and other assets	(46)	(65)
Net cash used in investing activities	(318)	(177)
Cash flows from financing activities:
Proceeds from exercise of stock options	0	3
Proceeds from long-term debt	0	35,000
Payments of deferred financing costs	(206)	(1,129)
Payment of long-term debt	0	(21,668)
Net cash (used in) provided by financing activities	(206)	12,206
Effect of exchange rate changes on cash	(95)	18
Net change in cash, cash equivalents and restricted cash	(6,882)	5,985
Cash, cash equivalents and restricted cash at beginning of year	30,921	25,007
Cash, cash equivalents and restricted cash at end of period	24,039	30,992
Supplemental disclosure of cash flow information:
Cash paid for interest	814	1,160
Cash paid for income taxes	7	0
Right-of-use assets recognized in exchange for new lease obligations (non-cash)	$ 36	$ 2,789

Organization and Business Descr

Organization and Business Description	3 Months Ended
	Mar. 31, 2020
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 gastroenterologists to address a variety of closure needs in the gastrointestinal tract and used by gastroenterologists and bariatric surgeons to treat obesity. The Company's core products include the OverStitch™ Endoscopic Suturing System ("ESS") and the Orbera® Intragastric Balloon System ("IGB"), which together comprise the Company's Endoscopy products. The Company also offers Apollo Care, a digital and remotely delivered aftercare program. All devices are regulated by the U.S. Food and Drug Administration (the "FDA") or an equivalent regulatory body outside the U.S. The Company has offices in the United Kingdom and Italy that oversee commercial activities outside the U.S. and a products manufacturing facility in Costa Rica. All other activities are managed and operated from facilities in Austin, Texas. Going Concern Uncertainty ASC Topic 205-40, Presentation of Financial Statements - Going Concern (“ASC 205-40”), requires management to assess the Company’s ability to continue as a going concern for one year after the date the financial statements are issued. Under ASC 205-40, management has the responsibility to evaluate whether conditions and/or events raise substantial doubt about the Company’s ability to meet future financial obligations as they become due within one year after the date that the financial statements are issued. As required by this standard, management’s evaluation shall initially not take into consideration the potential mitigating effects of management’s plans that have not been fully implemented as of the date the financial statements are issued. The Company has experienced operating losses since inception and expects its negative cash flows from operating activities to continue. The reduction in sales due to the COVID-19 pandemic and uncertainty over how long the COVID-19 impact on the Company's business will last, along with the existing capital resources of the Company, has raised substantial doubt about the Company’s ability to continue as a going concern within one year of the issuance date of these condensed consolidated financial statements. The Company will likely require additional funding in order to meet its covenant requirements. In this regard, management’s plans include, but are not limited to, sales of the Company's common stock, preferred stock, convertible debt securities or debt financings, reduction of planned expenditures, and other sources. There are no assurances that such additional funding will be obtained, regarding the degree or duration that the COVID-19 pandemic will negatively have on the Company's business, or that the Company will succeed in its future operations. If the Company cannot successfully raise additional capital and implement its business plan, its liquidity, financial condition and business prospects will be materially and adversely affected.

Significant Accounting Policies

Significant Accounting Policies	3 Months Ended
	Mar. 31, 2020
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 the Company's Annual Report on Form 10-K for the year ended December 31, 2019. (c) Recent Accounting Pronouncements On January 1, 2020, the Company adopted the provision of ASU 2017-04, Intangibles - Goodwill and Other: Simplifying the Test for Goodwill Impairment (“ASU 2017-04”). The guidance removes step two of the goodwill impairment test, which requires a hypothetical purchase price allocation. A goodwill impairment will now be the amount by which a reporting unit’s carrying value exceeds its fair value, not to exceed the carrying amount of goodwill. Entities will continue to have the option to perform a qualitative assessment to determine if a quantitative impairment test is necessary.

Concentrations

Concentrations	3 Months Ended
	Mar. 31, 2020
Risks and Uncertainties [Abstract]
Concentrations	Concentrations Consolidated financial instruments that potentially subject the Company to a concentration of credit risk principally consist of cash and cash equivalents and accounts receivable. At March 31, 2020, the Company's cash, cash equivalents and restricted cash are held in deposit accounts at five different banks totaling $24,039. 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 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 monitors the compliance of its customers with the Company's payment terms, but generally requires no collateral. The Company had one customer representing approximately 15% of the Company's net accounts receivable balance as of December 31, 2019. There were no concentrations greater than 10% of the Company's net accounts receivable as of March 31, 2020. The Company had no single customer that comprised more than 10% of the Company's total revenues for the three months ended March 31, 2020 and 2019.

Inventory

Inventory	3 Months Ended
	Mar. 31, 2020
Inventory Disclosure [Abstract]
Inventory	Inventory Inventory consists of the following as of: March 31, 2020 December 31, 2019 (unaudited) Raw materials $ 2,594 $ 2,834 Work in progress 639 532 Finished goods 7,012 5,499 Total inventory $ 10,245 $ 8,865

Property, Equipment and Right-o

Property, Equipment and Right-of-Use Assets	3 Months Ended
	Mar. 31, 2020
Property, Plant and Equipment [Abstract]
Property, Equipment and Right-of-Use Assets	Property, Equipment and Right-of-Use Assets Property, equipment and right-of-use assets consists of the following: Depreciable Lives March 31, 2020 December 31, 2019 (unaudited) Equipment 5 years $ 7,480 $ 7,491 Right-of-use assets 1-5 years 2,883 2,890 Furniture, fixtures and tooling 4-8 years 2,141 2,233 Computer hardware 3-5 years 1,237 1,261 Leasehold improvements 3-5 years 1,745 1,671 Construction in process 330 198 15,816 15,744 Less accumulated depreciation (9,610) (9,132) Property, equipment and right-of-use assets $ 6,206 $ 6,612 The Company recorded depreciation expense of $458 and $503 for the three months ended March 31, 2020 and 2019, respectively. There were no impairment charges for the three months ended March 31, 2020 and 2019, respectively. The Company disposed of $189 of fully depreciated property, equipment and right-of-use assets no longer being utilized during the three months ended March 31, 2020 . The Company has operating leases for office space in Texas, the United Kingdom, and Italy, and for the manufacturing facility located in Costa Rica. The Company also has various lease agreements for equipment and vehicles. As of March 31, 2020, the maturities of the Company's operating lease liabilities are as follows: 2020 $ 862 2021 924 2022 179 2023 92 2024 28 Thereafter — Total lease payments 2,085 Less imputed interest (234) Total operating lease liabilities $ 1,851 Operating lease liabilities of $955 and $932 are included in accrued expenses and $896 and $1,116 are included in long-term liabilities, as of March 31, 2020 and December 31, 2019, respectively. Operating lease expense and cash paid within operating cash flows for operating leases was $294 and $333 for the three months ended March 31, 2020 and 2019, respectively. As of March 31, 2020, the weighted average remaining lease term was 1.95 years and the weighted average discount rate used to estimate the value of the operating lease liabilities was 9.6%.

Other Assets

Other Assets	3 Months Ended
	Mar. 31, 2020
Deferred Costs, Capitalized, Prepaid, and Other Assets Disclosure [Abstract]
Other Assets	Other AssetsIncluded in other assets as of March 31, 2020 and December 31, 2019 is $2,573 and $2,511 for the non-current portion of the remaining $5,000 receivable due from ReShape, respectively, for the remaining unpaid consideration from the divestiture of the Surgical product line in December 2018. Interest on the receivable accretes 10% annually. Imputed interest income on the ReShape receivable was $106 and $172 for the three months ended March 31, 2020 and 2019, respectively, and is included within interest expense, net.

Accrued Expenses

Accrued Expenses	3 Months Ended
	Mar. 31, 2020
Payables and Accruals [Abstract]
Accrued Expenses	Accrued Expenses Accrued expenses consists of the following as of: March 31, 2020 December 31, 2019 (unaudited) Accrued employee compensation and expenses $ 2,930 $ 3,183 Settlement liability 1,625 1,625 Lease liability 955 932 Accrued professional service fees 1,290 653 Accrued interest 300 467 Accrued insurance and taxes 318 271 Accrued returns and rebates 57 216 Other 1,138 1,091 Total accrued expenses $ 8,613 $ 8,438

Long-Term Debt

Long-Term Debt	3 Months Ended
	Mar. 31, 2020
Debt Disclosure [Abstract]
Long-Term Debt	Long-Term Debt Long-term debt consists of the following as of: March 31, 2020 December 31, 2019 (unaudited) Term loan facility $ 35,000 $ 35,000 Payment-in-kind interest 679 517 Deferred financing costs (1,198) (1,068) Less current portion (34,481) (34,449) Long-term debt $ — $ — In March 2019, the Company entered into a Term Loan Facility (the "Credit Agreement") with Solar Capital Ltd. ("Solar") to borrow $35,000. The Credit Agreement matures on September 1, 2023, with principal payments beginning in March 2021, and bears interest at the greater of LIBOR or 1.35575%, plus 7.5%. Interest only is payable in arrears until March 1, 2021 (or July 1, 2021 if certain revenue milestones are achieved). Principal payments are due on a straight-line basis after the interest-only period concludes. An additional 4.9% of the outstanding amount will be due at end of the loan term and an additional 4.5% fee of the Term Loan funded amount will be due at the earlier of an Exit Event (as defined in the Credit Agreement) or if the Company achieves trailing twelve-month revenue of $100,000 before March 15, 2029. The Credit Agreement provides that the Company may borrow an additional $5,000 upon its request, subject to further credit approval. The Credit Agreement includes customary affirmative covenants, negative covenants and financial covenants, including a minimum liquidity requirement and minimum product revenues. The Company used $22,372 of the proceeds of the Credit Agreement to repay its previous senior secured credit agreement in full including interest. Unamortized deferred financing costs and discount of $388 were written off in March 2019 in connection with the repayment. In March 2020, the Company entered into the Fourth Amendment and Limited Waiver to the Credit Agreement which (i) established the trailing six-month Endoscopy revenue requirements for 2020, (ii) will provide an additional $10,000 of funding upon the achievement of these revenue requirements through June 2020, (iii) extended the interest-only period until July 1, 2021, if certain revenue milestones are achieved, (iv) requires the Company to raise additional cash of $15,000 from debt or equity financing by August 2020, (v) established a minimum LIBOR interest rate, and (vi) waived the financial statement covenant default associated with the going concern opinion of the Company's independent registered public accounting firm for the year ended December 31, 2019. Due to the negative impact of COVID-19 on the Company's revenues, the Company will unlikely be eligible to access the $10,000 of additional funding under the Fourth Amendment. In April 2020, the Company entered into the Fifth Amendment and Limited Waiver to the Credit Agreement. See Note 15 for further details. As of March 31, 2020, the Company was in compliance with all financial covenants. Interest expense on the Company's long term debt was $1,041 and $1,274 for the three months ended March 31, 2020 and 2019, respectively. The Company has classified its long-term debt obligations with long-term contractual maturities as current liabilities at March 31, 2020 and December 31, 2019 based on the Company's assessment that it may not be able to meet the debt covenant requirements included in the Credit Agreement for at least one year from the issuance of the condensed consolidated financial statements considering factors such as the uncertainties from the COVID-19 pandemic. The contractual terms of the Credit Agreement set out principal payments as follows: 2020 $ — 2021 11,667 2022 14,000 2023 9,333 2024 — Thereafter — $ 35,000

Convertible Debt

Convertible Debt	3 Months Ended
	Mar. 31, 2020
Debt Disclosure [Abstract]
Convertible Debt	Convertible Debt Convertible debt consists of the following as of: March 31, 2020 December 31, 2019 (unaudited) Convertible debt $ 20,000 $ 20,000 Deferred financing costs (1,368) (1,446) Total convertible debt $ 18,632 $ 18,554 In August 2019, the Company issued $20,000 aggregate principal amount of 6.0% convertible senior debentures due 2024 (the "Convertible Debt"), primarily to existing stockholders and officers of the Company. Interest on the Convertible Debt is payable semi-annually in shares of the Company's common stock on January 1 and July 1 of each year at a rate of 6.0% per year. The number of shares of common stock required to settle the amount of interest payable will be based on the volume-weighted average price ("VWAP") of the Company's common stock for the 10 consecutive trading days immediately preceding the applicable interest payment date. The Convertible Debt will mature on August 12, 2024 unless earlier converted or repurchased in accordance with its terms. In January 2020, the Company issued 164,797 shares of the Company's common stock to holders of the Convertible Debt in fulfillment of $467 of accrued interest as of December 31, 2019. The Convertible Debt converts, at the option of the holders, into shares of the Company's common stock at an initial conversion price of $3.25 per share, subject to adjustment. If the VWAP of the Company's common stock has been at least $9.75 (subject to adjustment) for at least 20 trading days during any 30 consecutive trading day period, the Company may force the conversion of all or any part of the outstanding principal amount of the Convertible Debt, accrued and unpaid interest and any other amounts then owing, subject to certain conditions. Interest expense on the Convertible Debt was $378 for the three months ended March 31, 2020.

Stock Based Compensation

Stock Based Compensation	3 Months Ended
	Mar. 31, 2020
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Stock Based Compensation	Stock Based CompensationIn 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" and 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 March 31, 2020 is presented below. Options Weighted Average Exercise Price Weighted Average Remaining Contractual Term Aggregate Intrinsic Value Options outstanding, December 31, 2019 1,927,194 $5.01 7.5 years $87 Options forfeited (30,338) $5.22 Options outstanding, vested and expected to vest, March 31, 2020 1,896,856 $5.01 7.2 years $10 Options exercisable 1,051,196 $5.30 6.1 years $10 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. No options were granted during the three months ended March 31, 2020 and 2019. Additional information regarding options is as follows: Three Months Ended March 31, 2020 Three Months Ended March 31, 2019 Aggregate intrinsic value of options exercised during the period $ — $ 2 The aggregate intrinsic value in the tables above represents the total pre-tax value of the options shown, calculated as the difference between the Company’s closing stock price on March 31, 2020 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 March 31, 2020 and sold the shares thereby received at the closing price of the Company’s common stock on that date. This amount changes based on the closing price of the Company’s common stock. The total compensation cost recognized for stock-based awards was $401 and $323 for the three months ended March 31, 2020 and 2019, respectively. Unrecognized compensation expense related to unvested options was approximately $1,986 at March 31, 2020, with a remaining amortization period of 2.2 years. A summary of the restricted stock unit activity under the Company's Equity Plans as of March 31, 2020 is presented below. Units Weighted Average Grant Date Fair Value Aggregate Intrinsic Value Unvested units, December 31, 2019 243,695 $4.06 $695 Restricted stock units vested (11,341) $6.58 Unvested units, March 31, 2020 232,354 $3.94 $446 Unrecognized compensation expense related to unvested restricted stock units was approximately $689 at March 31, 2020, with a remaining amortization period of 2.6 years.

Income Taxes

Income Taxes	3 Months Ended
	Mar. 31, 2020
Income Tax Disclosure [Abstract]
Income Taxes	Income Taxes The provision for income taxes for the three months ended March 31, 2020 and 2019 primarily consists of foreign income taxes. The Company has established a valuation allowance due to uncertainties regarding the realization of deferred tax assets based on the Company's lack of earnings history and potential limitations pursuant to changes in ownership under Internal Revenue Code Section 382. On March 27, 2020, the Coronavirus Aid, Relief, and Economic Security ("CARES") Act was signed into law making several changes to the Internal Revenue Code; however, the tax law changes in the Act did not have a material impact on the Company’s income tax provision. As of March 31, 2020, the Company has no unrecognized tax benefits or accrued interest or penalties associated with uncertain tax positions.

Net Loss Per Share

Net Loss Per Share	3 Months Ended
	Mar. 31, 2020
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, convertible debt, 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 March 31, 2020 2019 Warrants for common stock 1,204,371 251,189 Convertible debt 6,293,076 — Common stock options 1,896,856 1,481,631 Restricted stock units 232,354 73,691 9,626,657 1,806,511

Liquidity and Capital Resources

Liquidity and Capital Resources	3 Months Ended
	Mar. 31, 2020
Debt Disclosure [Abstract]
Liquidity and Capital Resources	Liquidity and Capital ResourcesThe Company

Fair Value Measurements

Fair Value Measurements	3 Months Ended
	Mar. 31, 2020
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 and Convertible Debt is estimated by management to approximate $38,000 and $20,000, respectively at March 31, 2020. 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	3 Months Ended
	Mar. 31, 2020
Segment Reporting [Abstract]
Segment and Geographic Information	Segment and Geographic InformationOperating 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 March 31, 2020 Three Months Ended March 31, 2019 (unaudited) U.S. OUS Total Revenues % Total Revenues U.S. OUS Total Revenues % Total Revenues ESS $ 3,755 $ 3,077 $ 6,832 63.7 % $ 3,007 $ 3,491 $ 6,498 49.2 % IGB 898 2,628 3,526 32.9 % 1,459 2,863 4,322 32.7 % Total Endoscopy 4,653 5,705 10,358 96.6 % 4,466 6,354 10,820 81.9 % Surgical — — — — % — 1,700 1,700 12.9 % Other 327 33 360 3.4 % 683 8 691 5.2 % Total revenues $ 4,980 $ 5,738 $ 10,718 100.0 % $ 5,149 $ 8,062 $ 13,211 100.0 % % Total revenues 46.5 % 53.5 % 39.0 % 61.0 % Total distributor sales were 34.0% and 27.9% of total OUS revenues for the three months ended March 31, 2020 and 2019, respectively. Sales in the largest individual country outside the U.S. was 8.1% and 9.2% of total revenues for the three months ended March 31, 2020 and 2019, respectively. The following table represents property, equipment and right-of-use assets, net based on the geographic location of the asset: March 31, 2020 December 31, 2019 (unaudited) United States $ 2,906 $ 2,934 Costa Rica 2,762 3,039 Other 538 639 Total property, equipment and right-of-use assets, net $ 6,206 $ 6,612

Subsequent Events

Subsequent Events	3 Months Ended
	Mar. 31, 2020
Subsequent Events [Abstract]
Subsequent Events	Subsequent Events On April 15, 2020, the Compensation Committee of the Board of Directors of the Company, approved a comprehensive plan to continue to preserve the Company’s liquidity given the ongoing business disruptions resulting from the international efforts to contain the spread of COVID-19. As part of this plan, the Company furloughed 57 U.S. employees and reduced the employment arrangements of an additional 34 employees outside the United States, effective April 20, 2020. In addition, the base salary of all employees was capped at $100,000, including the Company’s Chief Executive Officer, Chief Financial Officer and other executive officers, effective April 16, 2020. On April 30, 2020, the Company entered into the Fifth Amendment and Limited Waiver to the Credit Agreement which (i) permits the Company to enter into a loan under the Small Business Administration’s Paycheck Protection Program ("PPP") established under the CARES Act, (ii) waives the trailing six-month Endoscopy revenue requirements for the second and third quarter of 2020 and reduces the revenue requirements for the fourth quarter of 2020, (iii) increases the minimum liquidity requirement to $17,500 until the earlier of August 14, 2020 or when the Company meets the requirement to raise additional capital of $15,000, at which time the minimum liquidity requirement increases to $20,000, and decreases the minimum liquidity requirement to $12,500 in January 2021 if revenue covenant compliance is maintained for October and November 2020, (iv) provides a limited waiver on the monthly financial statement reporting requirements through June 2020, and (v) increases the final fee due at end of the loan term to 5.0% from 4.9%. On April 27, 2020, the Company was granted a loan (the "Loan") of $2,824 under the PPP established under the CARES Act. The Loan matures on April 27, 2022 and bears interest at a rate of 1.0% per annum with equal interest and principal payments beginning on November 27, 2020.

Significant Accounting Polici_2

Significant Accounting Policies (Policies)	3 Months Ended
	Mar. 31, 2020
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 gastroenterologists to address a variety of closure needs in the gastrointestinal tract and used by gastroenterologists and bariatric surgeons to treat obesity. The Company's core products include the OverStitch™ Endoscopic Suturing System ("ESS") and the Orbera® Intragastric Balloon System ("IGB"), which together comprise the Company's Endoscopy products. The Company also offers Apollo Care, a digital and remotely delivered aftercare program. All devices are regulated by the U.S. Food and Drug Administration (the "FDA") or an equivalent regulatory body outside the U.S. The Company has offices in the United Kingdom and Italy that oversee commercial activities outside the U.S. and a products manufacturing facility in Costa Rica. All other activities are managed and operated from facilities in Austin, Texas.
Recent Accounting Pronouncements	Recent Accounting Pronouncements On January 1, 2020, the Company adopted the provision of ASU 2017-04, Intangibles - Goodwill and Other: Simplifying the Test for Goodwill Impairment (“ASU 2017-04”). The guidance removes step two of the goodwill impairment test, which requires a hypothetical purchase price allocation. A goodwill impairment will now be the amount by which a reporting unit’s carrying value exceeds its fair value, not to exceed the carrying amount of goodwill. Entities will continue to have the option to perform a qualitative assessment to determine if a quantitative impairment test is necessary.
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, convertible debt, 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)	3 Months Ended
	Mar. 31, 2020
Inventory Disclosure [Abstract]
Schedule of Inventory	Inventory consists of the following as of: March 31, 2020 December 31, 2019 (unaudited) Raw materials $ 2,594 $ 2,834 Work in progress 639 532 Finished goods 7,012 5,499 Total inventory $ 10,245 $ 8,865

Property, Equipment and Right_2

Property, Equipment and Right-of-Use Assets (Tables)	3 Months Ended
	Mar. 31, 2020
Property, Plant and Equipment [Abstract]
Schedule of Property and Equipment	Property, equipment and right-of-use assets consists of the following: Depreciable Lives March 31, 2020 December 31, 2019 (unaudited) Equipment 5 years $ 7,480 $ 7,491 Right-of-use assets 1-5 years 2,883 2,890 Furniture, fixtures and tooling 4-8 years 2,141 2,233 Computer hardware 3-5 years 1,237 1,261 Leasehold improvements 3-5 years 1,745 1,671 Construction in process 330 198 15,816 15,744 Less accumulated depreciation (9,610) (9,132) Property, equipment and right-of-use assets $ 6,206 $ 6,612
Operating Lease Maturity	As of March 31, 2020, the maturities of the Company's operating lease liabilities are as follows: 2020 $ 862 2021 924 2022 179 2023 92 2024 28 Thereafter — Total lease payments 2,085 Less imputed interest (234) Total operating lease liabilities $ 1,851

Accrued Expenses (Tables)

Accrued Expenses (Tables)	3 Months Ended
	Mar. 31, 2020
Payables and Accruals [Abstract]
Schedule of Accrued Expenses	Accrued expenses consists of the following as of: March 31, 2020 December 31, 2019 (unaudited) Accrued employee compensation and expenses $ 2,930 $ 3,183 Settlement liability 1,625 1,625 Lease liability 955 932 Accrued professional service fees 1,290 653 Accrued interest 300 467 Accrued insurance and taxes 318 271 Accrued returns and rebates 57 216 Other 1,138 1,091 Total accrued expenses $ 8,613 $ 8,438

Long-Term Debt (Tables)

Long-Term Debt (Tables)	3 Months Ended
	Mar. 31, 2020
Debt Disclosure [Abstract]
Schedule of Long-term Debt	Long-term debt consists of the following as of: March 31, 2020 December 31, 2019 (unaudited) Term loan facility $ 35,000 $ 35,000 Payment-in-kind interest 679 517 Deferred financing costs (1,198) (1,068) Less current portion (34,481) (34,449) Long-term debt $ — $ —
Schedule of Maturities of Long-term Debt	The Company has classified its long-term debt obligations with long-term contractual maturities as current liabilities at March 31, 2020 and December 31, 2019 based on the Company's assessment that it may not be able to meet the debt covenant requirements included in the Credit Agreement for at least one year from the issuance of the condensed consolidated financial statements considering factors such as the uncertainties from the COVID-19 pandemic. The contractual terms of the Credit Agreement set out principal payments as follows: 2020 $ — 2021 11,667 2022 14,000 2023 9,333 2024 — Thereafter — $ 35,000

Convertible Debt (Tables)

Convertible Debt (Tables)	3 Months Ended
	Mar. 31, 2020
Debt Disclosure [Abstract]
Schedule of Convertible Debt	Convertible debt consists of the following as of: March 31, 2020 December 31, 2019 (unaudited) Convertible debt $ 20,000 $ 20,000 Deferred financing costs (1,368) (1,446) Total convertible debt $ 18,632 $ 18,554

Stock Based Compensation (Table

Stock Based Compensation (Tables)	3 Months Ended
	Mar. 31, 2020
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 March 31, 2020 is presented below. Options Weighted Average Exercise Price Weighted Average Remaining Contractual Term Aggregate Intrinsic Value Options outstanding, December 31, 2019 1,927,194 $5.01 7.5 years $87 Options forfeited (30,338) $5.22 Options outstanding, vested and expected to vest, March 31, 2020 1,896,856 $5.01 7.2 years $10 Options exercisable 1,051,196 $5.30 6.1 years $10
Schedule of Other Stock Option Information	Additional information regarding options is as follows: Three Months Ended March 31, 2020 Three Months Ended March 31, 2019 Aggregate intrinsic value of options exercised during the period $ — $ 2
Schedule of Restricted Stock Unit Activity	A summary of the restricted stock unit activity under the Company's Equity Plans as of March 31, 2020 is presented below. Units Weighted Average Grant Date Fair Value Aggregate Intrinsic Value Unvested units, December 31, 2019 243,695 $4.06 $695 Restricted stock units vested (11,341) $6.58 Unvested units, March 31, 2020 232,354 $3.94 $446

Net Loss Per Share (Tables)

Net Loss Per Share (Tables)	3 Months Ended
	Mar. 31, 2020
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 March 31, 2020 2019 Warrants for common stock 1,204,371 251,189 Convertible debt 6,293,076 — Common stock options 1,896,856 1,481,631 Restricted stock units 232,354 73,691 9,626,657 1,806,511

Segment and Geographic Inform_2

Segment and Geographic Information (Tables)	3 Months Ended
	Mar. 31, 2020
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 March 31, 2020 Three Months Ended March 31, 2019 (unaudited) U.S. OUS Total Revenues % Total Revenues U.S. OUS Total Revenues % Total Revenues ESS $ 3,755 $ 3,077 $ 6,832 63.7 % $ 3,007 $ 3,491 $ 6,498 49.2 % IGB 898 2,628 3,526 32.9 % 1,459 2,863 4,322 32.7 % Total Endoscopy 4,653 5,705 10,358 96.6 % 4,466 6,354 10,820 81.9 % Surgical — — — — % — 1,700 1,700 12.9 % Other 327 33 360 3.4 % 683 8 691 5.2 % Total revenues $ 4,980 $ 5,738 $ 10,718 100.0 % $ 5,149 $ 8,062 $ 13,211 100.0 % % Total revenues 46.5 % 53.5 % 39.0 % 61.0 %
Schedule of Long-Lived Assets by Geographic Area	The following table represents property, equipment and right-of-use assets, net based on the geographic location of the asset: March 31, 2020 December 31, 2019 (unaudited) United States $ 2,906 $ 2,934 Costa Rica 2,762 3,039 Other 538 639 Total property, equipment and right-of-use assets, net $ 6,206 $ 6,612

Concentrations (Details)

Concentrations (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2019USD ($)	Mar. 31, 2020USD ($)bank	Mar. 31, 2019USD ($)	Dec. 31, 2018USD ($)
Concentration Risk [Line Items]
Number of banks | bank		5
Cash and cash equivalents and restricted cash | $	$ 30,921	$ 24,039	$ 30,992	$ 25,007
One Customer | Accounts Receivable | Customer Concentration Risk
Concentration Risk [Line Items]
Concentration risk, percentage	15.00%

Inventory (Details)

Inventory (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019	Dec. 31, 2019
Inventory Disclosure [Abstract]
Raw materials	$ 2,594		$ 2,834
Work in progress	639		532
Finished goods	7,012		5,499
Total inventory	10,245		$ 8,865
Inventory impairment	0	$ 40
Consigned inventory	$ 115

Property, Equipment and Right_3

Property, Equipment and Right-of-Use Assets (Details) - USD ($)	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019	Dec. 31, 2019
Property, Plant and Equipment [Line Items]
Right-of-use assets	$ 2,883,000		$ 2,890,000
Property and equipment, gross	15,816,000		15,744,000
Less accumulated depreciation	(9,610,000)		(9,132,000)
Property, equipment and right-of-use assets	6,206,000		6,612,000
Depreciation	458,000	$ 503,000
Impairment charges	0	$ 0
Disposals	$ 189,000
Minimum
Property, Plant and Equipment [Line Items]
Depreciable Lives, Right of use assets	1 year
Maximum
Property, Plant and Equipment [Line Items]
Depreciable Lives, Right of use assets	5 years
Equipment
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 7,480,000		7,491,000
Depreciable Lives	5 years
Furniture, fixtures and tooling
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 2,141,000		2,233,000
Furniture, fixtures and tooling | Minimum
Property, Plant and Equipment [Line Items]
Depreciable Lives	4 years
Furniture, fixtures and tooling | Maximum
Property, Plant and Equipment [Line Items]
Depreciable Lives	8 years
Computer hardware
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 1,237,000		1,261,000
Computer hardware | Minimum
Property, Plant and Equipment [Line Items]
Depreciable Lives	3 years
Computer hardware | Maximum
Property, Plant and Equipment [Line Items]
Depreciable Lives	5 years
Leasehold improvements
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 1,745,000		1,671,000
Leasehold improvements | Minimum
Property, Plant and Equipment [Line Items]
Depreciable Lives	3 years
Leasehold improvements | Maximum
Property, Plant and Equipment [Line Items]
Depreciable Lives	5 years
Construction in process
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 330,000		$ 198,000

Property, Equipment and Right_4

Property, Equipment and Right-of-Use Assets (Lease Maturity) (Details) $ in Thousands	Mar. 31, 2020USD ($)
Property, Plant and Equipment [Abstract]
2020	$ 862
2021	924
2022	179
2023	92
2024	28
Thereafter	0
Total lease payments	2,085
Less imputed interest	(234)
Total operating lease liabilities	$ 1,851

Property, Equipment and Right_5

Property, Equipment and Right-of-Use Assets (Lease Narrative) (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019	Dec. 31, 2019
Property, Plant and Equipment [Abstract]
Operating lease in accrued expenses	$ 955		$ 932
Long-term lease liability	896		$ 1,116
Cash paid within operating cash flows for operating leases	$ 294	$ 333
Weighted average remaining lease term	1 year 11 months 12 days
Weighted average discount rate, percent	9.60%

Other Assets (Details)

Other Assets (Details) - Surgical Product Line - Disposal - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019	Dec. 31, 2019	Dec. 31, 2018
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Non-current receivable	$ 2,573		$ 2,511
Remaining receivable				$ 5,000
Interest income	$ 106	$ 172
Discount Rate
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Interest on the receivable percentage				10.00%

Accrued Expenses (Details)

Accrued Expenses (Details) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Payables and Accruals [Abstract]
Accrued employee compensation and expenses	$ 2,930	$ 3,183
Settlement liability	1,625	1,625
Lease liability	955	932
Accrued professional service fees	1,290	653
Accrued interest	300	467
Accrued insurance and taxes	318	271
Accrued returns and rebates	57	216
Other	1,138	1,091
Total accrued expenses	$ 8,613	$ 8,438

Long-Term Debt (Schedule of Lon

Long-Term Debt (Schedule of Long-term Debt) (Details) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Debt Instrument [Line Items]
Deferred financing costs	$ (1,198)	$ (1,068)
Less current portion	(34,481)	(34,449)
Long-term debt	0	0
Payment-in-kind interest
Debt Instrument [Line Items]
Long-term debt	679	517
Line of Credit | Term Loan Facility
Debt Instrument [Line Items]
Long-term debt	$ 35,000	$ 35,000

Long-Term Debt (Narrative) (Det

Long-Term Debt (Narrative) (Details) - USD ($)	1 Months Ended	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2020	Mar. 31, 2019
Debt Instrument [Line Items]
Line of credit		$ 35,000,000
Interest expense		1,041,000	$ 1,274,000
Line of Credit | Term Loan Facility
Debt Instrument [Line Items]
Line of credit	$ 35,000,000		$ 35,000,000
Interest rate if basis spread on variable rate is not used	1.35575%		1.35575%
Percent of outstanding amount due	4.90%
Commitment fee percentage	4.50%
Twelve month revenue amount	$ 100,000
Increase in limit	$ 5,000,000		$ 5,000,000
Line of Credit | Term Loan Facility | LIBOR
Debt Instrument [Line Items]
Basis spread on variable rate	7.50%
Line of Credit | Senior Secured Credit Facility
Debt Instrument [Line Items]
Repayments of debt	$ 22,372,000
Unamortized deferred financing costs and discount	$ 388,000
Line of Credit | Fourth Amendment and Limited Waiver
Debt Instrument [Line Items]
Increase in limit		10,000,000
Increase in minimum cash balance required		$ 15,000,000

Long-Term Debt (Schedule of Mat

Long-Term Debt (Schedule of Maturity of Long-term Debt) (Details) $ in Thousands	Mar. 31, 2020USD ($)
Debt Disclosure [Abstract]
2020	$ 0
2021	11,667
2022	14,000
2023	9,333
2024	0
Thereafter	0
Total	$ 35,000

Convertible Debt (Schedule of C

Convertible Debt (Schedule of Convertible Debt) (Details) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Debt Instrument [Line Items]
Deferred financing costs	$ (1,198)	$ (1,068)
Long-term debt	0	0
Convertible Debt
Debt Instrument [Line Items]
Convertible debt	20,000	20,000
Deferred financing costs	(1,368)	(1,446)
Long-term debt	$ 18,632	$ 18,554

Convertible Debt (Narrative) (D

Convertible Debt (Narrative) (Details) $ / shares in Units, $ in Thousands	1 Months Ended		3 Months Ended
	Jan. 31, 2020shares	Aug. 31, 2019USD ($)d$ / shares	Mar. 31, 2020USD ($)	Mar. 31, 2019USD ($)	Dec. 31, 2019USD ($)
Debt Instrument [Line Items]
Interest expense			$ 1,041	$ 1,274
Convertible Debt
Debt Instrument [Line Items]
Proceeds from convertible debt		$ 20,000
Interest rate		6.00%
Issuance of common stock for Convertible Debt interest, shares | shares	164,797
Accrued interest					$ 467
Interest expense			$ 378
Convertible Debt | Conversion Ratio Less Than 2.50
Debt Instrument [Line Items]
Consecutive trading days (in days) | d		10
Convertible Debt | Conversion Ratio Of 3.25
Debt Instrument [Line Items]
Consecutive trading days (in days) | d		30
Conversion price (USD per share) | $ / shares		$ 3.25
Stock price trigger (USD per share) | $ / shares		$ 9.75
Trading days (in days) | d		20

Stock Based Compensation (Stock

Stock Based Compensation (Stock Option Activity) (Details) - Stock Option - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended	12 Months Ended
	Mar. 31, 2020	Dec. 31, 2019
Options
Options outstanding, beginning balance (in shares)		1,927,194
Options forfeited (in shares)	(30,338)
Options vested and expected to vest (in shares)	1,896,856
Options exercisable (in shares)	1,051,196
Weighted Average Exercise Price
Weighted average exercise price, beginning balance (in USD per share)		$ 5.01
Options forfeited (in USD per share)	$ 5.22
Options vested and expected to vest (in USD per share)	5.01
Options exercisable (in USD per share)	$ 5.30
Weighted Average Remaining Contractual Term
Weighted Average Remaining Contractual Term		7 years 6 months
Options vested and expected to vest	7 years 2 months 12 days
Options exercisable	6 years 1 month 6 days
Aggregate Intrinsic Value
Aggregate intrinsic value		$ 87
Options vested and expected to vest	$ 10
Options exercisable	$ 10

Stock Based Compensation (Addit

Stock Based Compensation (Additional Information) (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Options granted (in shares)	0	0
Share-based compensation	$ 401	$ 323
Unrecognized compensation expense related to unvested options	$ 1,986
Remaining amortization period	2 years 2 months 12 days
Stock Option
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Aggregate intrinsic value of options exercised during the period	$ 0	$ 2
Restricted Stock Units
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Remaining amortization period	2 years 7 months 6 days
Unrecognized compensation expense related to unvested restricted stock units	$ 689

Stock Based Compensation (Restr

Stock Based Compensation (Restricted Stock Units Activity) (Details) - Restricted Stock Units - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended
	Mar. 31, 2020	Dec. 31, 2019
Units
Unvested Units (shares)	243,695
Restricted stock units vested (shares)	(11,341)
Unvested Units (shares)	232,354
Weighted Average Grant Date Fair Value
Unvested Units (USD per share)	$ 4.06
Restricted stock units vested (USD per share)	6.58
Unvested Units (USD per share)	$ 3.94
Aggregate Intrinsic Value
Aggregate Intrinsic Value	$ 446	$ 695

Income Taxes (Details)

Income Taxes (Details)	Mar. 31, 2020USD ($)
Income Tax Disclosure [Abstract]
Unrecognized tax benefits	$ 0
Accrued interest	0
Tax penalties	$ 0

Net Loss Per Share (Details)

Net Loss Per Share (Details) - shares	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of diluted loss per share	9,626,657	1,806,511
Warrants for common stock
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of diluted loss per share	1,204,371	251,189
Convertible Debt
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of diluted loss per share	6,293,076	0
Common stock options
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of diluted loss per share	1,896,856	1,481,631
Restricted Stock Units
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of diluted loss per share	232,354	73,691

Liquidity and Capital Resourc_2

Liquidity and Capital Resources (Details) $ in Thousands	1 Months Ended
	Aug. 31, 2019USD ($)d	Mar. 31, 2019USD ($)	Mar. 31, 2020USD ($)	Dec. 31, 2019USD ($)
Debt Instrument [Line Items]
Accumulated deficit			$ 260,418	$ 250,162
Line of credit			$ 35,000
Convertible Debt
Debt Instrument [Line Items]
Proceeds from convertible debt	$ 20,000
Interest rate	6.00%
Convertible Debt | Conversion Ratio Less Than 2.50
Debt Instrument [Line Items]
Consecutive trading days (in days) | d	10
Term Loan Facility | Line of Credit
Debt Instrument [Line Items]
Line of credit		$ 35,000
Senior Secured Credit Facility | Line of Credit
Debt Instrument [Line Items]
Repayments of debt		$ 22,372

Fair Value Measurements (Detail

Fair Value Measurements (Details) $ in Thousands	Mar. 31, 2020USD ($)
Fair Value Disclosures [Abstract]
Convertible debt, fair value	$ 20,000
Fair value of long-term debt	$ 38,000

Segment and Geographic Inform_3

Segment and Geographic Information (Segment Information) (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2020USD ($)segment	Mar. 31, 2019USD ($)
Segment Reporting [Abstract]
Number of reportable segments | segment	1
Revenue, Major Customer [Line Items]
Revenues	$ 10,718	$ 13,211
Segment Revenue | Product Risk
Revenue, Major Customer [Line Items]
Percentage of revenue or sales	100.00%	100.00%
U.S.
Revenue, Major Customer [Line Items]
Revenues	$ 4,980	$ 5,149
U.S. | Segment Revenue | Product Risk
Revenue, Major Customer [Line Items]
Percentage of revenue or sales	46.50%	39.00%
OUS
Revenue, Major Customer [Line Items]
Revenues	$ 5,738	$ 8,062
OUS | Segment Revenue | Product Risk
Revenue, Major Customer [Line Items]
Percentage of revenue or sales	53.50%	61.00%
OUS | Distributor Sales | Product Risk
Revenue, Major Customer [Line Items]
Percentage of revenue or sales	34.00%	27.90%
Non-US, Next Largest Single Country | Distributor Sales | Product Risk
Revenue, Major Customer [Line Items]
Percentage of revenue or sales	8.10%	9.20%
ESS
Revenue, Major Customer [Line Items]
Revenues	$ 6,832	$ 6,498
ESS | Segment Revenue | Product Risk
Revenue, Major Customer [Line Items]
Percentage of revenue or sales	63.70%	49.20%
ESS | U.S.
Revenue, Major Customer [Line Items]
Revenues	$ 3,755	$ 3,007
ESS | OUS
Revenue, Major Customer [Line Items]
Revenues	3,077	3,491
IGB
Revenue, Major Customer [Line Items]
Revenues	$ 3,526	$ 4,322
IGB | Segment Revenue | Product Risk
Revenue, Major Customer [Line Items]
Percentage of revenue or sales	32.90%	32.70%
IGB | U.S.
Revenue, Major Customer [Line Items]
Revenues	$ 898	$ 1,459
IGB | OUS
Revenue, Major Customer [Line Items]
Revenues	2,628	2,863
Endoscopy
Revenue, Major Customer [Line Items]
Revenues	$ 10,358	$ 10,820
Endoscopy | Segment Revenue | Product Risk
Revenue, Major Customer [Line Items]
Percentage of revenue or sales	96.60%	81.90%
Endoscopy | U.S.
Revenue, Major Customer [Line Items]
Revenues	$ 4,653	$ 4,466
Endoscopy | OUS
Revenue, Major Customer [Line Items]
Revenues	5,705	6,354
Surgical
Revenue, Major Customer [Line Items]
Revenues	$ 0	$ 1,700
Surgical | Segment Revenue | Product Risk
Revenue, Major Customer [Line Items]
Percentage of revenue or sales	0.00%	12.90%
Surgical | U.S.
Revenue, Major Customer [Line Items]
Revenues	$ 0	$ 0
Surgical | OUS
Revenue, Major Customer [Line Items]
Revenues	0	1,700
Other
Revenue, Major Customer [Line Items]
Revenues	$ 360	$ 691
Other | Segment Revenue | Product Risk
Revenue, Major Customer [Line Items]
Percentage of revenue or sales	3.40%	5.20%
Other | U.S.
Revenue, Major Customer [Line Items]
Revenues	$ 327	$ 683
Other | OUS
Revenue, Major Customer [Line Items]
Revenues	$ 33	$ 8

Segment and Geographic Inform_4

Segment and Geographic Information (Long-Lived Assets by Geographic Area) (Details) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Revenues from External Customers and Long-Lived Assets [Line Items]
Total property, equipment and right-of-use assets, net	$ 6,206	$ 6,612
U.S.
Revenues from External Customers and Long-Lived Assets [Line Items]
Total property, equipment and right-of-use assets, net	2,906	2,934
Costa Rica
Revenues from External Customers and Long-Lived Assets [Line Items]
Total property, equipment and right-of-use assets, net	2,762	3,039
Other
Revenues from External Customers and Long-Lived Assets [Line Items]
Total property, equipment and right-of-use assets, net	$ 538	$ 639

Subsequent Events (Details)

Subsequent Events (Details) - Subsequent Event	Apr. 30, 2020USD ($)	Apr. 20, 2020d	Apr. 15, 2020USD ($)	Apr. 27, 2020USD ($)
Fifth Amendment and Limited Waiver | Line of Credit
Subsequent Event [Line Items]
Percent of outstanding amount due	5.00%
Fifth Amendment and Limited Waiver | Line of Credit | Earlier of August 14, 2020
Subsequent Event [Line Items]
Increase in minimum liquidity requirement	$ 17,500,000
Increase in minimum cash balance required	15,000,000
Fifth Amendment and Limited Waiver | Line of Credit | January 2021
Subsequent Event [Line Items]
Increase in minimum liquidity requirement	20,000,000
Decrease in minimum liquidity requirement	$ 12,500,000
Loan Under CARES ACT
Subsequent Event [Line Items]
Long-term debt				$ 2,824,000
Interest rate				1.00%
U.S.
Subsequent Event [Line Items]
Number of employees furloughed | d		57
OUS
Subsequent Event [Line Items]
Number of employees furloughed | d		34
COVID-19
Subsequent Event [Line Items]
Maximum base salary			$ 100,000