Apollo Endosurgery (APEN) 10-K 25 Feb 21 2020 FY Annual report Financial data

Cover Page

Cover Page - USD ($)	12 Months Ended
	Dec. 31, 2020	Jan. 31, 2021	Jun. 30, 2020
Cover [Abstract]
Document Type	10-K
Document Annual Report	true
Document Period End Date	Dec. 31, 2020
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, $0.001 par value per share
Trading Symbol	APEN
Security Exchange Name	NASDAQ
Entity Well-known Seasoned Issuer	No
Entity Voluntary Filers	No
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 Public Float			$ 34,656,093
Entity Common Stock, Shares Outstanding		25,983,847
Documents Incorporated by Reference	DOCUMENTS INCORPORATED BY REFERENCE Portions of the Definitive Proxy Statement for the registrant’s 2021 Annual Meeting of Stockholders are incorporated by reference into Part III of this Annual Report on Form 10-K. The Definitive Proxy Statement will be filed no later than 120 days after the close of the registrant’s fiscal year ended December 31, 2020.
Entity Central Index Key	0001251769
Current Fiscal Year End Date	--12-31
Amendment Flag	false
Document Fiscal Year Focus	2020
Document Fiscal Period Focus	FY

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Current assets:
Cash and cash equivalents	$ 36,235	$ 29,905
Accounts receivable, net of allowance for doubtful accounts of $634 and $658, respectively	8,218	9,232
Inventory	10,306	8,865
Prepaid expenses and other current assets	3,771	2,998
Total current assets	58,530	51,000
Restricted cash	965	1,016
Property, equipment and right-of-use assets	6,221	6,612
Goodwill	5,290	5,290
Intangible assets, net of accumulated amortization of $13,231 and $11,648, respectively	6,017	7,831
Other assets	414	2,833
Total assets	77,437	74,582
Current liabilities:
Accounts payable	3,675	9,902
Accrued expenses	7,357	8,438
Current portion of long-term debt	636	34,449
Total current liabilities	11,668	52,789
Long-term debt	37,192	0
Convertible debt	19,387	18,554
Long-term liabilities	2,439	1,116
Total liabilities	70,686	72,459
Commitments and contingencies
Stockholders' equity:
Common stock; $0.001 par value; 100,000,000 shares authorized; 25,819,329 and 20,951,963 shares issued and outstanding at December 31, 2020 and 2019, respectively	26	21
Additional paid-in capital	276,569	250,634
Accumulated other comprehensive income	2,929	1,630
Accumulated deficit	(272,773)	(250,162)
Total stockholders' equity	6,751	2,123
Total liabilities and stockholders' equity	$ 77,437	$ 74,582

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Statement of Financial Position [Abstract]
Allowance for doubtful accounts	$ 634	$ 658
Accumulated amortization, intangible assets	$ 13,231	$ 11,648
Common stock, par value (USD per share)	$ 0.001	$ 0.001
Common stock, shares authorized (in shares)	100,000,000	100,000,000
Common stock, shares issued (in shares)	25,819,329	20,951,963
Common stock, shares outstanding (in shares)	25,819,329	20,951,963

Consolidated Statements of Oper

Consolidated Statements of Operations and Comprehensive Loss - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Income Statement [Abstract]
Revenues	$ 42,048	$ 50,713
Cost of sales	19,806	25,038
Gross margin	22,242	25,675
Operating expenses:
Sales and marketing	17,355	28,730
General and administrative	11,062	13,588
Research and development	7,670	10,384
Amortization of intangible assets	1,949	2,095
Settlement gain	0	(5,609)
Total operating expenses	38,036	49,188
Loss from operations	(15,794)	(23,513)
Other expenses:
Interest expense, net	5,251	4,052
Other (income) expense	1,424	(408)
Net loss before income taxes	(22,469)	(27,157)
Income tax expense	142	275
Net loss	(22,611)	(27,432)
Other comprehensive income (loss):
Foreign currency translation	1,299	(871)
Comprehensive loss	$ (21,312)	$ (28,303)
Net loss per share, basic and diluted (USD per share)	$ (0.99)	$ (1.27)
Shares used in computing net loss per share, basic and diluted (shares)	22,756,167	21,542,284

Consolidated Statements of Chan

Consolidated Statements of Changes in Stockholders’ Equity - USD ($) $ in Thousands	Total	Adoption of ASU 2016-02, Leases	Common Stock	Additional Paid-in Capital	Accumulated Other Comprehensive Income	Accumulated Deficit	Accumulated DeficitAdoption of ASU 2016-02, Leases
Beginning balance (shares) at Dec. 31, 2018			21,899,522
Beginning balance at Dec. 31, 2018	$ 28,830	$ 78	$ 22	$ 249,115	$ 2,501	$ (222,808)	$ 78
Stockholders' Equity:
Exercise of common stock options (shares)			17,158
Exercise of common stock options	31			31
Exchange for warrants (in shares)			(1,000,000)
Exchange of common stock for warrants			$ (1)	1
Issuance of restricted stock units (shares)			35,283
Stock-based compensation	1,487			1,487
Foreign currency translation	(871)				(871)
Net loss	$ (27,432)					(27,432)
Ending balance (shares) at Dec. 31, 2019	20,951,963		20,951,963
Ending balance at Dec. 31, 2019	$ 2,123		$ 21	250,634	1,630	(250,162)
Stockholders' Equity:
Exercise of common stock options (shares)			5,982
Exercise of common stock options	14			14
Exchange for warrants (in shares)			2,105,836
Exchange of common stock for warrants			$ 2	(2)
Issuance of restricted stock units (shares)			85,223
Issuance of common stock for convertible debt interest (in shares)			164,797
Issuance of common stock for convertible debt interest	467			467
Issuance of common stock, net of issuance costs of $1,721 (shares)			2,480,000
Issuance of common stock, net of issuance costs of $1,721	23,262		$ 3	23,259
Conversion of convertible debt (in shares)			25,528
Conversion of convertible debt	83			83
Stock-based compensation	2,114			2,114
Foreign currency translation	1,299				1,299
Net loss	$ (22,611)					(22,611)
Ending balance (shares) at Dec. 31, 2020	25,819,329		25,819,329
Ending balance at Dec. 31, 2020	$ 6,751		$ 26	$ 276,569	$ 2,929	$ (272,773)

Consolidated Statements of Ch_2

Consolidated Statements of Changes in Stockholders’ Equity (Parenthetical) $ in Thousands	12 Months Ended
	Dec. 31, 2020USD ($)
Statement of Stockholders' Equity [Abstract]
Stock issuance costs	$ 1,721

Consolidated Statements of Cash

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Cash flows from operating activities:
Net loss	$ (22,611)	$ (27,432)
Adjustments to reconcile net loss to net cash used in operating activities:
Depreciation and amortization	3,730	4,060
Amortization of deferred financing costs	656	620
Non-cash interest	1,501	540
Provision for doubtful accounts receivable	52	212
Inventory impairment	50	162
Stock-based compensation	2,114	1,487
Unrealized foreign exchange on intercompany payables	1,208	(214)
Settlement gain	0	(5,609)
Changes in operating assets and liabilities:
Accounts receivable	1,079	1,852
Inventory	(1,559)	872
Prepaid expenses and other assets	56	(120)
Accounts payable and accrued expenses	(7,088)	(2,052)
Net cash used in operating activities	(20,812)	(25,622)
Cash flows from investing activities:
Purchases of property and equipment	(486)	(805)
Purchases of intangibles and other assets	(144)	(175)
Proceeds from sale of equipment	0	18
Divestiture of Surgical product line	2,000	2,000
Net cash provided by investing activities	1,370	1,038
Cash flows from financing activities:
Proceeds from exercise of stock options	14	31
Proceeds from long-term debt	2,824	35,000
Proceeds from convertible debt	0	20,000
Proceeds from issuance of common stock	23,262	0
Payments of deferred financing costs	(487)	(2,857)
Payment of long-term debt	0	(21,668)
Net cash provided by financing activities	25,613	30,506
Effect of exchange rate changes on cash	108	(8)
Net increase in cash, cash equivalents and restricted cash	6,279	5,914
Cash, cash equivalents and restricted cash at beginning of year	30,921	25,007
Cash, cash equivalents and restricted cash at end of year	37,200	30,921
Supplemental disclosure of cash flow information:
Cash paid for interest	3,182	3,470
Cash paid for income taxes	192	328
Right-of-use assets recognized in exchange for new lease obligations (non-cash)	$ 1,146	$ 2,890

Organization and Business Descr

Organization and Business Description	12 Months Ended
	Dec. 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 to advance gastrointestinal therapeutic endoscopy. The Company develops and distributes devices that are used by gastroenterologists and surgeons for a variety of procedures related to closing gastrointestinal defects and managing surgical or endoscopic adverse events and obesity intervention. 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. In December 2020, the Company received 510(k) approval for the X-Tack Endoscopic HeliX Tacking System. All devices are regulated by the U.S. Food and Drug Administration (the "FDA") or an equivalent regulatory body outside the U.S.

Significant Accounting Policies

Significant Accounting Policies	12 Months Ended
	Dec. 31, 2020
Accounting Policies [Abstract]
Significant Accounting Policies	Significant Accounting Policies (a) Principles of Consolidation The consolidated financial statements include the accounts of the Company and all of its wholly-owned subsidiaries. All significant intercompany accounts and transactions have been eliminated. (b) Use of Estimates The preparation of consolidated financial statements in conformity with accounting principles generally accepted in the U.S. ("U.S. GAAP") requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the consolidated financial statements and the reported amounts of revenues and expenses during the reporting periods. Actual results are likely to differ from those estimates, and such differences may be material to the consolidated financial statements. Significant items subject to such estimates and assumptions include revenue recognition, going concern assessment, useful lives of intangibles and long-lived assets, long-lived asset and goodwill impairment, allowance for doubtful accounts, and valuation of inventory. (c) Cash and Cash Equivalents The Company considers all highly liquid investments with a remaining maturity at date of purchase of three months or less to be cash equivalents. (d) Restricted Cash The Company entered into irrevocable letters of credit with three banks to secure obligations under lease agreements and performance based obligations. These letters of credit are secured by cash balances totaling $965 and $1,016 which are recorded in restricted cash on the consolidated balance sheet as of December 31, 2020 and 2019, respectively. (e) Accounts Receivable The Company generally extends credit to certain customers without requiring collateral. The Company provides an allowance for doubtful accounts based on management's evaluation of the collectability of accounts receivable. Accounts receivable are written off when it is deemed uncollectible. Accounts receivable of $115 and $127 were written off during the years ended December 31, 2020 and 2019, respectively. (f) Inventory Inventory is stated at the lower of cost or net realizable value. Charges for excess and obsolete inventory are based on specific identification of obsolete inventory items and an analysis of inventory items approaching expiration date. The Company records estimated excess and obsolescence charges to cost of sales. The Company's inventories are stated using the weighted average cost approach, which approximates actual costs. (g) Fair Value Measurements The carrying amounts of the Company's financial instruments, which primarily include cash and 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 $41,100 and $38,000 at December 31, 2020 and 2019, respectively. The Company's convertible debt is estimated by management to approximate $20,500 and $20,000 at December 31, 2020 and 2019, respectively. 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. (h) Property and Equipment Property and equipment are carried at cost less accumulated depreciation. Depreciation is computed using the straight-line method over the estimated useful lives of the related assets, except for leasehold improvements, which are depreciated straight-line over the shorter of the estimated useful life or the life of the lease. Major renewals and betterments are capitalized. Validation costs (including materials and labor) that are required to bring machinery to working condition are capitalized. Expenditures for repairs and maintenance and minor replacements are charged to expense as incurred. (i) Leases Lease arrangements are generally recognized at lease commitment. Operating lease right-of-use assets and liabilities are recognized at commencement based on the present value of lease payments over the lease term, except for leases with an initial term of 12 months or less, for which lease expense is recognized as incurred over the lease term. Right-of-use assets represent the Company’s right to use an underlying asset during the reasonably certain lease term, and lease liabilities represent the Company’s obligation to make lease payments arising from the lease. Lease terms may include options to extend or terminate the lease when its reasonably certain that the Company will exercise that option. The Company primarily uses its incremental borrowing rate based on the information available at commencement date in determining the present value of lease payments. Operating lease right-of-use assets include any lease payments related to initial direct costs and prepayments and excludes lease incentives. Lease expense is recognized on a straight-line basis over the lease term. The Company has lease agreements with lease and non-lease components, which are generally accounted for separately. (j) Goodwill and Other Intangible Assets Goodwill is not amortized but is tested annually for impairment or more frequently if impairment indicators exist. For annual and interim goodwill impairment tests, the Company first assesses qualitative factors before performing a quantitative assessment of the fair value of a reporting unit. If it is determined on the basis of qualitative factors that the fair value of the reporting unit is more likely than not less than the carrying amount, a quantitative impairment test is required. The Company's evaluation of goodwill completed on December 31, 2020 and 2019 resulted in no impairment losses. Definite-lived intangible assets consist of customer relationships, product technology, trade names, patents and trademarks and capitalized software which are amortized over their estimated useful lives. Costs to extend the lives of and renew patents and trademarks are capitalized when incurred. (k) Valuation of Long-Lived Assets Long-lived assets, including definite-lived intangible assets, are monitored and reviewed for impairment whenever events or changes in circumstances indicate that the carrying amount of any such asset may not be recoverable. The determination of recoverability is based on an estimate of undiscounted cash flows expected to result from the use of an asset and its eventual disposition. The estimate of undiscounted cash flows is based upon, among other things, certain assumptions about expected future operating performance. The Company's estimates of undiscounted cash flows may differ from actual cash flows. If the sum of the undiscounted cash flows is less than the carrying value of the asset, an impairment charge is recognized, measured as the amount by which the carrying value exceeds the fair value of the asset. The Company's evaluation of long-lived assets for the years ended December 31, 2020 and 2019 resulted in no impairment losses. (l) Revenue Recognition The Company's principal source of revenues is from the sale of its products. Revenue is recognized when control of the promised goods is transferred to the customer, in an amount that reflects the consideration expected to be entitled to in an exchange for those goods. Generally, these 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. The Company's 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. The Company estimates these amounts based on the expected amount to be provided to customers and reduces recognized revenues. The Company records 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. In connection with the December 2018 sale of the Surgical product line, the Company entered into a transition services agreement, supply agreement and distribution agreement. Transition service fees were recognized as revenue when the support was provided in accordance with the prices established in the transition services agreement. Product sold under the supply agreement is recognized as revenue when product is shipped at the prices established in the supply agreement net of the cost to produce the product. Transition service and supply agreement revenue are included in other revenue. All transition, distribution, and manufacturing services were completed as of December 31, 2020. (m) Research and Development Research and development costs are expensed as incurred. (n) Stock-based Compensation Plans The Company recognizes compensation costs for all stock-based awards based upon each award's estimated fair value as determined on the date of grant. The Company utilizes the Black-Scholes option-pricing model to determine the fair value of stock option awards. Compensation cost is recognized on a straight-line basis over the respective vesting period of the award. Adjustments for actual forfeitures are made in the period which they occur. (o) Advertising The Company expenses advertising costs as incurred. The Company incurred approximately $227 and $1,648 in advertising costs during the years ended December 31, 2020 and 2019, respectively. (p) Income Taxes The Company accounts for deferred income taxes using the asset and liability method. Under this method, deferred income taxes arise from temporary differences between the tax basis of assets and liabilities and their reported amounts in the financial statements, which will result in taxable or deductible amounts in the future. Temporary differences are then measured using the enacted tax rates and laws. Valuation allowances are established, when necessary, to reduce deferred tax assets to the amount that is more-likely than-not to be realized. Determining the appropriate amount of valuation allowance requires management to exercise judgment about future operations. In the ordinary course of business, there are many transactions for which the ultimate tax outcome is uncertain. The Company regularly assesses uncertain tax positions in each of the tax jurisdictions in which it has operations and accounts for the related consolidated financial statement implications. The amount of unrecognized tax benefits is adjusted when information becomes available or when an event occurs indicating a change is appropriate. The Company includes interest and penalties related to its uncertain tax positions as part of income tax expense. (q) Foreign Currency The Company translates foreign assets and liabilities at exchange rates in effect at the balance sheet dates, and the revenues and expenses using average rates during the year. The resulting foreign currency translation adjustments are recorded as a separate component of accumulated other comprehensive income in the accompanying consolidated balance sheets. Exchange rate fluctuations on short-term intercompany loans are included in other expense in the consolidated statement of operations and comprehensive loss. (r) Recent Accounting Pronouncements In March 2020, ASU No. 2020-04, Reference Rate Reform (Topic 848): Facilitation of the Effects of Reference Rate Reform on Financial Reporting

Concentrations

Concentrations	12 Months Ended
	Dec. 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 December 31, 2020, the Company's cash and cash equivalents and restricted cash are held in deposit accounts at five different banks totaling $37,200. 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 no concentrations greater than 10% of the Company's net accounts receivable balance as of December 31, 2020. There was one customer representing approximately 15% of the Company's net accounts receivable as of December 31, 2019. The Company had no single customer that comprised more than 10% of the Company's total revenues for the years ended December 31, 2020 and 2019.

Inventory

Inventory	12 Months Ended
	Dec. 31, 2020
Inventory Disclosure [Abstract]
Inventory	Inventory Inventory consists of the following as of December 31: 2020 2019 Raw materials $ 2,344 $ 2,834 Work in progress 558 532 Finished goods 7,404 5,499 Total inventory $ 10,306 $ 8,865

Property, Equipment and Right-o

Property, Equipment and Right-of-Use Assets	12 Months Ended
	Dec. 31, 2020
Property, Plant and Equipment [Abstract]
Property, Equipment and Right-of-Use Assets	Property, Equipment and Right-of-Use Assets Property and equipment consists of the following as of December 31: Depreciable Lives 2020 2019 Equipment 5 years $ 7,452 $ 7,491 Right-of-use assets 1 - 5 years 4,031 2,890 Furniture, fixtures and tooling 4 - 8 years 2,156 2,233 Computer hardware 3 - 5 years 1,244 1,261 Leasehold improvements 3 - 7 years 1,744 1,671 Construction in process 466 198 17,093 15,744 Less accumulated depreciation (10,872) (9,132) Property, equipment and right-of-use assets $ 6,221 $ 6,612 The Company recorded depreciation expense of $1,779 and $1,859 for the years ended December 31, 2020 and 2019, respectively. There were no impairment charges for the years ended December 31, 2020 or 2019. The Company disposed of $405 of fully depreciated property, equipment and right-of-use assets no longer being utilized during the year ended December 31, 2020. The Company has operating leases for office space in Texas, the United Kingdom, and Italy, and for the manufacturing facility in Costa Rica. In September 2020, the Company extended the lease of the manufacturing facility in Costa Rica. The Company also has various operating lease agreements for equipment and vehicles. As of December 31, 2020, the maturities of the Company's operating lease liabilities are as follows: 2021 $ 983 2022 566 2023 488 2024 424 2025 404 Thereafter 1,172 Total lease payments 4,037 Less imputed interest (1,032) Total operating lease liabilities $ 3,005 Operating lease liabilities of $675 and $2,330 are included in accrued expense long-term liabilities

Intangible Assets

Intangible Assets	12 Months Ended
	Dec. 31, 2020
Goodwill and Intangible Assets Disclosure [Abstract]
Intangible Assets	Intangible Assets Intangible assets consist of the following as of December 31: Useful Life 2020 2019 Customer relationships 9 years $ 8,301 $ 8,301 Orbera technology 12 years 4,600 4,600 Trade names 10 years 1,700 1,700 Patents and trademarks 5 years 2,597 2,453 Capitalized software 1 - 5 years 2,050 2,425 19,248 19,479 Less accumulated amortization (13,231) (11,648) Intangible assets, net $ 6,017 $ 7,831 The Company recorded amortization expense of $1,951 and $2,201 during 2020 and 2019, respectively. Additionally, $144 and $161 related to the extension and renewal of patents and trademarks was capitalized during 2020 and 2019, respectively. Amortization for the next five years is as follows: 2021 $ 1,851 2022 1,674 2023 908 2024 624 2025 564 Thereafter 396 Total $ 6,017

Other Assets

Other Assets	12 Months Ended
	Dec. 31, 2020
Deferred Costs, Capitalized, Prepaid, and Other Assets Disclosure [Abstract]
Other Assets	Other AssetsIncluded in other assets as of December 31, 2019 was $2,511 for the non-current portion of the receivable due from ReShape, which has been reclassified to other current assets as of December 31, 2020. Interest on the receivable accretes 10% annually. Imputed interest income on the ReShape receivable was $416 and $619 for the years ended December 31, 2020 and 2019, respectively, and is included within interest expense, net.

Accrued Expenses

Accrued Expenses	12 Months Ended
	Dec. 31, 2020
Payables and Accruals [Abstract]
Accrued Expenses	Accrued Expenses Accrued expenses consists of the following as of December 31: 2020 2019 Accrued employee compensation and expenses $ 3,946 $ 3,183 Lease liability 675 932 Accrued interest 616 467 Accrued professional service fees 358 653 Accrued insurance and taxes 442 271 Accrued returns and rebates 129 216 Settlement liability — 1,625 Other 1,191 1,091 Total accrued expenses $ 7,357 $ 8,438

Long-Term Debt

Long-Term Debt	12 Months Ended
	Dec. 31, 2020
Debt Disclosure [Abstract]
Long-Term Debt	Long-Term Debt Long-term debt consists of the following as of December 31: 2020 2019 Term loan facility $ 35,000 $ 35,000 PPP loan 2,824 — Deferred interest 1,217 517 Deferred financing costs (1,213) (1,068) Less current portion (636) (34,449) Long-term debt $ 37,192 $ — Term Loan Facility In March 2019, the Company entered into a Term Loan Facility (the "Credit Agreement") with Solar to borrow $35,000. The Credit Agreement, as amended by the Seventh Amendment, matures on September 1, 2024, with principal payments beginning in March 2022, and bears interest at LIBOR, subject to a minimum floor, plus 7.5%. Principal payments are due on a straight-line basis after the interest-only period concludes. An additional 7.0% of the outstanding amount will be due at end of the loan term and an additional 5.5% fee 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 December 4, 2030. The Credit Agreement, collateralized by substantially all of the Company's assets, includes the 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 our 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. The Credit Agreement was amended in March 2020, April 2020, July 2020 and December 2020. These amendments, among other things, (i) waived the trailing six-month Endoscopy revenue requirements through the end of 2020, (ii) reduced the minimum liquidity requirement to $12,500, (iii) extended the interest only period until March 1, 2022 (or September 1, 2022 if certain revenue milestones are achieved in 2021) and extended the maturity date to September 1, 2024 (or March 1, 2025 if certain revenue milestones are achieved in 2021), (iv) permitted the Company to enter into a loan under the Small Business Administration’s ("SBA") Paycheck Protection Program ("PPP") established under the Coronavirus Aid, Relief, and Economic Security (“CARES”) Act, (v) increased the final fee due at the end of the loan term to 7.0% from 4.9%, (vi) increased the fee due at certain exit or trigger events from 4.5% to 5.5%, (vii) waived the financial statement covenant default associated with the going concern opinion of our independent registered public accounting firm for the year ended December 31, 2019, and (viii) established a minimum LIBOR interest rate. In connection with these amendments and concurrent with the equity raise in July 2020, the Company reclassified the term loan facility from current liabilities to the scheduled maturity of the principal payments set out in the Credit Agreement. As of December 31, 2020, the Company was in compliance with all financial covenants. In February 2021, we entered into the Eighth Amendment to the Credit Agreement which established the revenue covenant requirements for 2021 (see Note 1 8 ). PPP Loan In March 2020, the CARES Act was signed into law providing certain economic aid packages for qualified entities. In April 2020, we were granted a loan of $2,824 under the PPP established under the CARES Act. The Loan matures on February 27, 2023 and bears interest at a rate of 1.0% per annum with equal interest and principal payments beginning on September 27, 2021. Under the terms of the CARES Act, PPP loan recipients can apply for and be granted forgiveness for all or a portion of the loan granted under the PPP, with such forgiveness to be determined, subject to limitations, based on the use of the loan proceeds for payment of payroll costs, rent, utilities, and interest on debt. The terms of any forgiveness may also be subject to further requirements in any regulations and guidelines the SBA may adopt. In June 2020, the PPP Flexibility Act was signed into law which, among other things, (i) extended the covered period from 8 weeks after the date of PPP funding to 24 weeks after the date of PPP funding, (ii) reduced the required amount of payroll expenditures from 75% to 60%, (iii) removed the prior ban on borrowers taking advantage of payroll tax deferral after loan forgiveness and (iv) extended the repayment deferral period to be the earlier of (a) the date forgiveness funds are received or (b) 10 months from the end of the covered period. In December 2020, the Company applied for forgiveness of the full amount of the $2,824 loan from the SBA. We will continue to include this PPP loan within our long-term debt until we receive confirmation of forgiveness from the SBA. Interest expense on the Company's long term debt was $4,212 and $4,579 for the years ended December 31, 2020 and 2019, respectively. Principal payments of the Company's long-term debt are as follows: 2021 $ 627 2022 13,550 2023 14,314 2024 9,333 2025 — Thereafter — Total $ 37,824

Convertible Debt

Convertible Debt	12 Months Ended
	Dec. 31, 2020
Debt Disclosure [Abstract]
Convertible Debt	Convertible debt Convertible debt consists of the following as of December 31: 2020 2019 Convertible debt principal $ 20,519 $ 20,000 Deferred financing costs (1,132) (1,446) Convertible debt $ 19,387 $ 18,554 In August 2019, the Company issued $20,000 aggregate principal amount of 6.0% convertible senior debentures (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 our common stock for the 10 consecutive trading days immediately preceding the applicable interest payment date. However, in the event that the trailing 10-trading day VWAP of the Company's common stock is less than $2.50 per share, interest accrued and payable for the applicable interest payment period will accrete to the principal amount then outstanding. The Convertible Debt will mature on August 12, 2026, as amended in December 2020, unless earlier converted or repurchased in accordance with its terms. In January 2020, we 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. In July 2020, outstanding interest of $600 was accreted to the principal amount of the Convertible Debt. As of December 31, 2020, accrued interest on the Convertible Debt was $616. The Convertible Debt converts, at the option of the holders, into shares of our common stock at an initial conversion price of $3.25 per share, subject to adjustment. If the VWAP of our common stock has been at least $9.75 (subject to adjustment) for at least 20 trading days during any 30 consecutive trading day period, we 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. In December 2020, $81 of the Convertible Debt was converted into 25,528 shares of common stock. Interest expense on the Convertible Debt was $1,531 and $588 for the years ended December 31, 2020 and 2019, respectively.

Stockholders' Equity

Stockholders' Equity	12 Months Ended
	Dec. 31, 2020
Equity [Abstract]
Stockholders' Equity	Stockholders' Equity (a) Authorized Stock The Company’s amended and restated certificate of incorporation, authorizes the Company to issue 115,000,000 shares of common and preferred stock, consisting of 100,000,000 shares of common stock with $0.001 par value and 15,000,000 shares of preferred stock with $0.001 par value. The Company has reserved common shares for issuance upon the exercise of the authorized and issued common stock options and warrants. (b) Warrants Warrants consist of the following as of December 31, 2020: Warrant Expiration Date Number of shares Exercise price per share December 29, 2021 40,456 $13.70 February 27, 2022 163,915 $21.29 No expiration 16,412,964 $0.001 Total number of warrants outstanding 16,617,335 Weighted average exercise price of warrants outstanding $0.24 In July 2020, the Company issued and sold (i) 2,480,000 shares of common stock, par value $0.001 per share at a purchase price of $1.25 per share, or the Shares, and (ii) pre-funded warrants to purchase up to 17,520,000 shares of common stock, or the Warrant Shares, at a purchase price of $1.249 per warrant, or the Warrants, for aggregate proceeds of approximately $25,000. In October 2020, 2,107,036 of these Warrants were exercised. No warrants expired during the year ended December 31, 2020.

Stock Option Plans

Stock Option Plans	12 Months Ended
	Dec. 31, 2020
Share-based Payment Arrangement [Abstract]
Stock Option Plans	Stock Option Plans Plans 2017 Plan The Company's 2017 Equity Incentive Plan (the "2017 Plan") was approved in June 2017 by the Company's stockholders. The 2017 plan covers employees, consultants, and nonemployee directors of the Company and provides for the grant of incentive stock options, nonstatutory stock options, stock appreciation rights, restricted stock awards, restricted stock units, performance stock awards, performance cash awards, and other stock awards to purchase shares of the Company's common stock. Options to date have been granted to employees at 100% of the fair value at the date of the grant. The fair value, vesting period, and expiration dates of the options granted are determined by the Board of Directors at the time of grant. The maximum term of options granted under the 2017 Plan is 10 years from the date of grant. Options generally vest over a period of time, typically not more than 5 years. The plan's reserve is automatically increased by 4% of the total number of shares outstanding at the prior year end for a period of ten years. 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 stock appreciation rights or options exercised by means of a net exercise will be deducted from the shares available under the 2017 Plan. Certain of the outstanding options were granted under prior equity incentive plans which are no longer in effect. As of December 31, 2020, the Company has 438,581 shares of common stock reserved for issuance under the 2017 Plan. 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 December 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 granted 1,216,942 $2.08 Options exercised (5,982) $2.31 Options forfeited (216,208) $4.13 Options outstanding, vested and expected to vest, December 31, 2020 2,921,946 $3.86 7.6 years $1,664 Options exercisable 1,364,859 $5.17 6.0 years $143 The fair value for options under the Equity Plans was estimated at the date of grant using the Black-Scholes option pricing model. The Black-Scholes model requires estimating dividend yield, volatility, risk-free rate of return during the service period and the expected term of the award. The expected dividend yield assumption is based on the Company’s expectation of zero future dividend payouts. The volatility assumption is based on the historical volatilities of the Company’s common stock and of comparable public companies. The risk free rate of return assumption utilizes yields on U.S. treasury zero-coupon bonds with maturity that is commensurate with the expected term for awards issued to employees and the contractual term for awards issued to non-employees. The expected term is derived using the simplified method and represents the weighted average period that the stock awards are expected to remain outstanding. 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 for the years ended December 31: 2020 2019 Risk free interest rate 0.4% 2.2% Expected dividend yield —% —% Estimated volatility 73.8% 64.6% Expected life 5.8 years 6.0 years Additional information regarding options is as follows: 2020 2019 Stock-based compensation cost $2,114 $1,487 Weighted-average grant date fair value of options granted during the period $1.31 $2.08 Aggregate intrinsic value of options exercised during the period $8 $20 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 December 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 December 31, 2020 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. Annually the Company grants options to its sales and marketing personnel that begin to time vest only upon the individual's achievement of a certain revenue target. In 2020, no options were determined to have met the underlying conditions. The remaining performance shares were unearned and forfeited. Unrecognized compensation expense related to unvested options was approximately $2,121 at December 31, 2020, with a remaining amortization period of less than 2.0 years. A summary of the restricted stock unit activity under the Company's Equity Plans as of December 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 granted 517,978 $2.08 Restricted stock units vested (85,223) $4.08 Restricted stock units forfeited (11,784) $2.08 Unvested units, December 31, 2020 664,666 $2.55 $2,260 Unrecognized compensation expense related to unvested restricted stock units was approximately $1,251 at December 31, 2020, with a remaining amortization period of 2.2 years.

Commitments and Contingencies

Commitments and Contingencies	12 Months Ended
	Dec. 31, 2020
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	Commitments and Contingencies (a) Risk Management The Company maintains various forms of insurance that the Company's management believes are adequate to reduce the exposure to these risks to an acceptable level. (b) Employment Agreements Certain executive officers are entitled to payments if they are terminated without cause or as a result of a change in control. Upon termination without cause, and not as a result of death or disability, each of such officers is entitled to receive a payment of base salary for three three (c) Litigation Management believes there are no claims or actions pending or threatened against the Company, the ultimate disposition of which would have a material impact on the Company's consolidated financial position, results of operations or cash flows.

Defined Contribution Plan

Defined Contribution Plan	12 Months Ended
	Dec. 31, 2020
Retirement Benefits [Abstract]
Defined Contribution Plan	Defined Contribution PlanThe Company sponsors defined contribution plans for employees in the U.S. and Europe. The cost of these plans, including employer contributions, was $504 and $698 for the years ended December 31, 2020 and 2019 respectively.

Income Taxes

Income Taxes	12 Months Ended
	Dec. 31, 2020
Income Tax Disclosure [Abstract]
Income Taxes	Income Taxes Income tax expense of $142 and $275 for the years ended December 31, 2020 and 2019, respectively is composed of foreign income taxes on earnings generated by foreign subsidiaries. Deferred income taxes reflect the net effects of temporary differences between the carrying amounts of assets and liabilities for financial reporting purposes and the amounts used for income tax purposes. Significant components of the Company's deferred taxes at December 31 are as follows: 2020 2019 Deferred tax assets: Capitalized transaction costs $ 279 $ 330 Intangible assets 1,100 1,105 Inventory valuation 28 242 Research and development credit 4,123 4,055 Interest expense carryforward 3,121 2,188 Foreign timing differences 578 238 Other 1,095 873 Net operating loss carryforwards 53,666 50,702 63,990 59,733 Deferred tax liabilities: Unremitted foreign earnings (463) (453) Depreciable assets (93) (185) (556) (638) Total net deferred tax assets 63,434 59,095 Less valuation allowance (63,243) (59,049) Net deferred tax assets (included in other assets) $ 191 $ 46 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. The valuation allowance increased by $4,194 during the year ended December 31, 2020, primarily as a result of changes in net operating loss. 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 December 31, 2020, the Company has no unrecognized tax benefits or accrued interest or penalties associated with uncertain tax positions. The Company's provision for income taxes differs from the expected tax expense amount computed by applying the statutory federal income tax rate of 21% to income before income taxes as a result of the following: 2020 2019 Tax at U.S. statutory rate $ (4,719) $ (5,703) State taxes, net of deferred benefit (536) (1,051) Foreign tax rate differential (327) (330) Foreign taxes (13) 22 Permanent differences 702 442 Research and development tax credit (313) (408) Other 365 478 Deferred tax adjustment 756 (1) Unremitted foreign earnings 33 6 Valuation allowance - current year 4,194 6,820 Income tax expense $ 142 $ 275 Income tax expense consists of the following: 2020 2019 Current taxes: U.S. state $ 11 $ — International 279 321 Total current income tax expense 290 321 Deferred taxes: International (148) (46) Total deferred income tax expense (148) (46) Income tax expense $ 142 $ 275 As of December 31, 2020, the Company had U.S. federal net operating loss carryforwards of approximately $223,602, of which $79,764 has an unlimited life and the remaining amount will expire in varying amounts beginning in 2025 if not utilized. The Company's July 2017 stock offering qualified as an ownership change under section 382 which resulted in a reduction of $100,825 in the Company’s U.S. federal net operating losses that will not be utilizable in the future, thus federal net operating loss carryforwards available to the Company as of December 31, 2020 were $122,777. However, the Company's deferred tax asset value for this section 382 reduction is not reflected in the table above until written off in a future tax return. There have been no additional section 382 reductions through December 31, 2020. The deferred tax asset associated with net operating loss carryforwards has been offset by a valuation allowance due to the uncertainty that the Company will achieve taxable income necessary to utilize the net operating loss carryforward in the future. The Company had state net operating loss carryforwards of approximately $108,111 which will begin to expire in varying amounts beginning in 2021, if not utilized. The Company had foreign net operating losses of approximately $2,382 which do not expire.

Net Loss Per Share

Net Loss Per Share	12 Months Ended
	Dec. 31, 2020
Earnings Per Share [Abstract]
Net Loss Per Share	Net Loss Per ShareThe basic and diluted net loss per common share presented in the consolidated statement of operations and comprehensive loss is calculated by dividing net loss 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 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): Year Ended December 31 2020 2019 Warrants for common stock 8,068,615 590,672 Convertible debt 6,310,621 2,440,904 Common stock options 2,520,029 1,699,410 Restricted stock units 487,636 169,808 17,386,901 4,900,794

Segment and Geographic Informat

Segment and Geographic Information	12 Months Ended
	Dec. 31, 2020
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: Year Ended December 31, 2020 Year Ended December 31, 2019 U.S. OUS Total Revenues % Total Revenues U.S. OUS Total Revenues % Total Revenues ESS $ 15,774 $ 9,955 $ 25,729 61.2 % $ 14,944 $ 13,365 $ 28,309 55.8 % IGB 5,045 9,739 14,784 35.2 % 5,162 11,678 16,840 33.2 % Total Endoscopy 20,819 19,694 40,513 96.4 % 20,106 25,043 45,149 89.0 % Surgical — — — — % — 3,712 3,712 7.3 % Other 1,453 82 1,535 3.6 % 1,815 37 1,852 3.7 % Total revenues $ 22,272 $ 19,776 $ 42,048 100.0 % $ 21,921 $ 28,792 $ 50,713 100.0 % % Total revenues 53.0 % 47.0 % 43.2 % 56.8 % Total distributor sales were 35.2% and 33.9% of total OUS revenues for the years ended December 31, 2020 and 2019, respectively. Sales in the next largest individual country outside the U.S. were 7.6% for both the years ended December 31, 2020 and 2019. The following table represents property, equipment and right-of-use assets based on the physical location of the asset: 2020 2019 U.S. $ 2,149 $ 2,934 Costa Rica 3,641 3,039 Other 431 639 Total property, equipment and right-of-use assets $ 6,221 $ 6,612

Subsequent Events

Subsequent Events	12 Months Ended
	Dec. 31, 2020
Subsequent Events [Abstract]
Subsequent Events	Subsequent EventsIn February 2021, the Company entered into the Eighth Amendment to the Credit Agreement which established the revenue covenant requirements for 2021.

Significant Accounting Polici_2

Significant Accounting Policies (Policies)	12 Months Ended
	Dec. 31, 2020
Accounting Policies [Abstract]
Principles of Consolidation	Principles of ConsolidationThe consolidated financial statements include the accounts of the Company and all of its wholly-owned subsidiaries. All significant intercompany accounts and transactions have been eliminated.
Use of Estimates	Use of EstimatesThe preparation of consolidated financial statements in conformity with accounting principles generally accepted in the U.S. ("U.S. GAAP") requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the consolidated financial statements and the reported amounts of revenues and expenses during the reporting periods. Actual results are likely to differ from those estimates, and such differences may be material to the consolidated financial statements. Significant items subject to such estimates and assumptions include revenue recognition, going concern assessment, useful lives of intangibles and long-lived assets, long-lived asset and goodwill impairment, allowance for doubtful accounts, and valuation of inventory.
Cash and Cash Equivalents	Cash and Cash EquivalentsThe Company considers all highly liquid investments with a remaining maturity at date of purchase of three months or less to be cash equivalents.
Restricted Cash	Restricted CashThe Company entered into irrevocable letters of credit with three banks to secure obligations under lease agreements and performance based obligations.
Accounts Receivable	Accounts ReceivableThe Company generally extends credit to certain customers without requiring collateral. The Company provides an allowance for doubtful accounts based on management's evaluation of the collectability of accounts receivable. Accounts receivable are written off when it is deemed uncollectible.
Inventory	InventoryInventory is stated at the lower of cost or net realizable value. Charges for excess and obsolete inventory are based on specific identification of obsolete inventory items and an analysis of inventory items approaching expiration date. The Company records estimated excess and obsolescence charges to cost of sales. The Company's inventories are stated using the weighted average cost approach, which approximates actual costs.
Fair Value Measurements	Fair Value Measurements The carrying amounts of the Company's financial instruments, which primarily include cash and 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 $41,100 and $38,000 at December 31, 2020 and 2019, respectively. The Company's convertible debt is estimated by management to approximate $20,500 and $20,000 at December 31, 2020 and 2019, respectively. 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.
Property and Equipment	Property and EquipmentProperty and equipment are carried at cost less accumulated depreciation. Depreciation is computed using the straight-line method over the estimated useful lives of the related assets, except for leasehold improvements, which are depreciated straight-line over the shorter of the estimated useful life or the life of the lease. Major renewals and betterments are capitalized. Validation costs (including materials and labor) that are required to bring machinery to working condition are capitalized. Expenditures for repairs and maintenance and minor replacements are charged to expense as incurred.
Leases	LeasesLease arrangements are generally recognized at lease commitment. Operating lease right-of-use assets and liabilities are recognized at commencement based on the present value of lease payments over the lease term, except for leases with an initial term of 12 months or less, for which lease expense is recognized as incurred over the lease term. Right-of-use assets represent the Company’s right to use an underlying asset during the reasonably certain lease term, and lease liabilities represent the Company’s obligation to make lease payments arising from the lease. Lease terms may include options to extend or terminate the lease when its reasonably certain that the Company will exercise that option. The Company primarily uses its incremental borrowing rate based on the information available at commencement date in determining the present value of lease payments. Operating lease right-of-use assets include any lease payments related to initial direct costs and prepayments and excludes lease incentives. Lease expense is recognized on a straight-line basis over the lease term. The Company has lease agreements with lease and non-lease components, which are generally accounted for separately.
Goodwill and Other Intangible Assets	Goodwill and Other Intangible Assets Goodwill is not amortized but is tested annually for impairment or more frequently if impairment indicators exist. For annual and interim goodwill impairment tests, the Company first assesses qualitative factors before performing a quantitative assessment of the fair value of a reporting unit. If it is determined on the basis of qualitative factors that the fair value of the reporting unit is more likely than not less than the carrying amount, a quantitative impairment test is required. The Company's evaluation of goodwill completed on December 31, 2020 and 2019 resulted in no impairment losses. Definite-lived intangible assets consist of customer relationships, product technology, trade names, patents and trademarks and capitalized software which are amortized over their estimated useful lives. Costs to extend the lives of and renew patents and trademarks are capitalized when incurred.
Valuation of Long-Lived Assets	Valuation of Long-Lived AssetsLong-lived assets, including definite-lived intangible assets, are monitored and reviewed for impairment whenever events or changes in circumstances indicate that the carrying amount of any such asset may not be recoverable. The determination of recoverability is based on an estimate of undiscounted cash flows expected to result from the use of an asset and its eventual disposition. The estimate of undiscounted cash flows is based upon, among other things, certain assumptions about expected future operating performance. The Company's estimates of undiscounted cash flows may differ from actual cash flows. If the sum of the undiscounted cash flows is less than the carrying value of the asset, an impairment charge is recognized, measured as the amount by which the carrying value exceeds the fair value of the asset.
Revenue Recognition	Revenue Recognition The Company's principal source of revenues is from the sale of its products. Revenue is recognized when control of the promised goods is transferred to the customer, in an amount that reflects the consideration expected to be entitled to in an exchange for those goods. Generally, these 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. The Company's 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. The Company estimates these amounts based on the expected amount to be provided to customers and reduces recognized revenues. The Company records 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. In connection with the December 2018 sale of the Surgical product line, the Company entered into a transition services agreement, supply agreement and distribution agreement. Transition service fees were recognized as revenue when the support was provided in accordance with the prices established in the transition services agreement. Product sold under the supply agreement is recognized as revenue when product is shipped at the prices established in the supply agreement net of the cost to produce the product. Transition service and supply agreement revenue are included in other revenue. All transition, distribution, and manufacturing services were completed as of December 31, 2020.
Research and Development	Research and DevelopmentResearch and development costs are expensed as incurred.
Stock-based Compensation Plans	Stock-based Compensation PlansThe Company recognizes compensation costs for all stock-based awards based upon each award's estimated fair value as determined on the date of grant. The Company utilizes the Black-Scholes option-pricing model to determine the fair value of stock option awards. Compensation cost is recognized on a straight-line basis over the respective vesting period of the award. Adjustments for actual forfeitures are made in the period which they occur.
Advertising	AdvertisingThe Company expenses advertising costs as incurred.
Income Taxes	Income Taxes The Company accounts for deferred income taxes using the asset and liability method. Under this method, deferred income taxes arise from temporary differences between the tax basis of assets and liabilities and their reported amounts in the financial statements, which will result in taxable or deductible amounts in the future. Temporary differences are then measured using the enacted tax rates and laws. Valuation allowances are established, when necessary, to reduce deferred tax assets to the amount that is more-likely than-not to be realized. Determining the appropriate amount of valuation allowance requires management to exercise judgment about future operations. In the ordinary course of business, there are many transactions for which the ultimate tax outcome is uncertain. The Company regularly assesses uncertain tax positions in each of the tax jurisdictions in which it has operations and accounts for the related consolidated financial statement implications. The amount of unrecognized tax benefits is adjusted when information becomes available or when an event occurs indicating a change is appropriate. The Company includes interest and penalties related to its uncertain tax positions as part of income tax expense.
Foreign Currency	Foreign CurrencyThe Company translates foreign assets and liabilities at exchange rates in effect at the balance sheet dates, and the revenues and expenses using average rates during the year. The resulting foreign currency translation adjustments are recorded as a separate component of accumulated other comprehensive income in the accompanying consolidated balance sheets. Exchange rate fluctuations on short-term intercompany loans are included in other expense in the consolidated statement of operations and comprehensive loss.
Recent Accounting Pronouncements	Recent Accounting Pronouncements In March 2020, ASU No. 2020-04, Reference Rate Reform (Topic 848): Facilitation of the Effects of Reference Rate Reform on Financial Reporting
Net Loss Per Share	The basic and diluted net loss per common share presented in the consolidated statement of operations and comprehensive loss is calculated by dividing net loss 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)	12 Months Ended
	Dec. 31, 2020
Inventory Disclosure [Abstract]
Schedule of Inventory	Inventory consists of the following as of December 31: 2020 2019 Raw materials $ 2,344 $ 2,834 Work in progress 558 532 Finished goods 7,404 5,499 Total inventory $ 10,306 $ 8,865

Property, Equipment and Right_2

Property, Equipment and Right-of-Use Assets (Tables)	12 Months Ended
	Dec. 31, 2020
Property, Plant and Equipment [Abstract]
Schedule of Property and Equipment	Property and equipment consists of the following as of December 31: Depreciable Lives 2020 2019 Equipment 5 years $ 7,452 $ 7,491 Right-of-use assets 1 - 5 years 4,031 2,890 Furniture, fixtures and tooling 4 - 8 years 2,156 2,233 Computer hardware 3 - 5 years 1,244 1,261 Leasehold improvements 3 - 7 years 1,744 1,671 Construction in process 466 198 17,093 15,744 Less accumulated depreciation (10,872) (9,132) Property, equipment and right-of-use assets $ 6,221 $ 6,612
Schedule of Lease Maturity	As of December 31, 2020, the maturities of the Company's operating lease liabilities are as follows: 2021 $ 983 2022 566 2023 488 2024 424 2025 404 Thereafter 1,172 Total lease payments 4,037 Less imputed interest (1,032) Total operating lease liabilities $ 3,005

Intangible Assets (Tables)

Intangible Assets (Tables)	12 Months Ended
	Dec. 31, 2020
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Intangible Assets	Intangible assets consist of the following as of December 31: Useful Life 2020 2019 Customer relationships 9 years $ 8,301 $ 8,301 Orbera technology 12 years 4,600 4,600 Trade names 10 years 1,700 1,700 Patents and trademarks 5 years 2,597 2,453 Capitalized software 1 - 5 years 2,050 2,425 19,248 19,479 Less accumulated amortization (13,231) (11,648) Intangible assets, net $ 6,017 $ 7,831
Schedule of Amortization Expense	Amortization for the next five years is as follows: 2021 $ 1,851 2022 1,674 2023 908 2024 624 2025 564 Thereafter 396 Total $ 6,017

Accrued Expenses (Tables)

Accrued Expenses (Tables)	12 Months Ended
	Dec. 31, 2020
Payables and Accruals [Abstract]
Schedule of Accrued Expenses	Accrued expenses consists of the following as of December 31: 2020 2019 Accrued employee compensation and expenses $ 3,946 $ 3,183 Lease liability 675 932 Accrued interest 616 467 Accrued professional service fees 358 653 Accrued insurance and taxes 442 271 Accrued returns and rebates 129 216 Settlement liability — 1,625 Other 1,191 1,091 Total accrued expenses $ 7,357 $ 8,438

Long-Term Debt (Tables)

Long-Term Debt (Tables)	12 Months Ended
	Dec. 31, 2020
Debt Disclosure [Abstract]
Schedule of Long-term Debt	Long-term debt consists of the following as of December 31: 2020 2019 Term loan facility $ 35,000 $ 35,000 PPP loan 2,824 — Deferred interest 1,217 517 Deferred financing costs (1,213) (1,068) Less current portion (636) (34,449) Long-term debt $ 37,192 $ —
Schedule of Maturities of Long-term Debt	Principal payments of the Company's long-term debt are as follows: 2021 $ 627 2022 13,550 2023 14,314 2024 9,333 2025 — Thereafter — Total $ 37,824

Convertible Debt (Tables)

Convertible Debt (Tables)	12 Months Ended
	Dec. 31, 2020
Debt Disclosure [Abstract]
Convertible Debt	Convertible debt consists of the following as of December 31: 2020 2019 Convertible debt principal $ 20,519 $ 20,000 Deferred financing costs (1,132) (1,446) Convertible debt $ 19,387 $ 18,554

Stockholders' Equity (Tables)

Stockholders' Equity (Tables)	12 Months Ended
	Dec. 31, 2020
Equity [Abstract]
Schedule of Warrants	Warrants consist of the following as of December 31, 2020: Warrant Expiration Date Number of shares Exercise price per share December 29, 2021 40,456 $13.70 February 27, 2022 163,915 $21.29 No expiration 16,412,964 $0.001 Total number of warrants outstanding 16,617,335 Weighted average exercise price of warrants outstanding $0.24

Stock Option Plans (Tables)

Stock Option Plans (Tables)	12 Months Ended
	Dec. 31, 2020
Share-based Payment Arrangement [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 December 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 granted 1,216,942 $2.08 Options exercised (5,982) $2.31 Options forfeited (216,208) $4.13 Options outstanding, vested and expected to vest, December 31, 2020 2,921,946 $3.86 7.6 years $1,664 Options exercisable 1,364,859 $5.17 6.0 years $143
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 for the years ended December 31: 2020 2019 Risk free interest rate 0.4% 2.2% Expected dividend yield —% —% Estimated volatility 73.8% 64.6% Expected life 5.8 years 6.0 years
Schedule of Other Stock Option Information	Additional information regarding options is as follows: 2020 2019 Stock-based compensation cost $2,114 $1,487 Weighted-average grant date fair value of options granted during the period $1.31 $2.08 Aggregate intrinsic value of options exercised during the period $8 $20
Schedule of Restricted Stock Unit Activity	A summary of the restricted stock unit activity under the Company's Equity Plans as of December 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 granted 517,978 $2.08 Restricted stock units vested (85,223) $4.08 Restricted stock units forfeited (11,784) $2.08 Unvested units, December 31, 2020 664,666 $2.55 $2,260

Income Taxes (Tables)

Income Taxes (Tables)	12 Months Ended
	Dec. 31, 2020
Income Tax Disclosure [Abstract]
Schedule of Deferred Tax Assets and Liabilities	Significant components of the Company's deferred taxes at December 31 are as follows: 2020 2019 Deferred tax assets: Capitalized transaction costs $ 279 $ 330 Intangible assets 1,100 1,105 Inventory valuation 28 242 Research and development credit 4,123 4,055 Interest expense carryforward 3,121 2,188 Foreign timing differences 578 238 Other 1,095 873 Net operating loss carryforwards 53,666 50,702 63,990 59,733 Deferred tax liabilities: Unremitted foreign earnings (463) (453) Depreciable assets (93) (185) (556) (638) Total net deferred tax assets 63,434 59,095 Less valuation allowance (63,243) (59,049) Net deferred tax assets (included in other assets) $ 191 $ 46
Schedule of Effective Income Tax Rate	The Company's provision for income taxes differs from the expected tax expense amount computed by applying the statutory federal income tax rate of 21% to income before income taxes as a result of the following: 2020 2019 Tax at U.S. statutory rate $ (4,719) $ (5,703) State taxes, net of deferred benefit (536) (1,051) Foreign tax rate differential (327) (330) Foreign taxes (13) 22 Permanent differences 702 442 Research and development tax credit (313) (408) Other 365 478 Deferred tax adjustment 756 (1) Unremitted foreign earnings 33 6 Valuation allowance - current year 4,194 6,820 Income tax expense $ 142 $ 275
Schedule of Components of Income Tax Expense (Benefit)	Income tax expense consists of the following: 2020 2019 Current taxes: U.S. state $ 11 $ — International 279 321 Total current income tax expense 290 321 Deferred taxes: International (148) (46) Total deferred income tax expense (148) (46) Income tax expense $ 142 $ 275

Net Loss Per Share (Tables)

Net Loss Per Share (Tables)	12 Months Ended
	Dec. 31, 2020
Earnings Per Share [Abstract]
Schedule of Antidilutive Securities Excluded from Computation of Diluted Loss Per Share	Potentially dilutive securities 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): Year Ended December 31 2020 2019 Warrants for common stock 8,068,615 590,672 Convertible debt 6,310,621 2,440,904 Common stock options 2,520,029 1,699,410 Restricted stock units 487,636 169,808 17,386,901 4,900,794

Segment and Geographic Inform_2

Segment and Geographic Information (Tables)	12 Months Ended
	Dec. 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: Year Ended December 31, 2020 Year Ended December 31, 2019 U.S. OUS Total Revenues % Total Revenues U.S. OUS Total Revenues % Total Revenues ESS $ 15,774 $ 9,955 $ 25,729 61.2 % $ 14,944 $ 13,365 $ 28,309 55.8 % IGB 5,045 9,739 14,784 35.2 % 5,162 11,678 16,840 33.2 % Total Endoscopy 20,819 19,694 40,513 96.4 % 20,106 25,043 45,149 89.0 % Surgical — — — — % — 3,712 3,712 7.3 % Other 1,453 82 1,535 3.6 % 1,815 37 1,852 3.7 % Total revenues $ 22,272 $ 19,776 $ 42,048 100.0 % $ 21,921 $ 28,792 $ 50,713 100.0 % % Total revenues 53.0 % 47.0 % 43.2 % 56.8 %
Schedule of Long-Lived Assets by Geographic Area	The following table represents property, equipment and right-of-use assets based on the physical location of the asset: 2020 2019 U.S. $ 2,149 $ 2,934 Costa Rica 3,641 3,039 Other 431 639 Total property, equipment and right-of-use assets $ 6,221 $ 6,612

Organization and Business Des_2

Organization and Business Description (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Divestiture of Surgical product line		$ 2,000	$ 2,000
Surgical Product Line | Disposal
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Notes receivable				$ 17
Surgical Product Line | Disposal | Forecast
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Divestiture of Surgical product line	$ 3

Significant Accounting Polici_3

Significant Accounting Policies (Narrative) (Details) - USD ($)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Restricted Cash
Restricted cash	$ 965,000	$ 1,016,000
Accounts Receivable
Accounts receivable write-offs	115,000	127,000
Fair Value Measurements
Long-term debt, fair value	41,100,000	38,000,000
Goodwill and Other Intangible Assets
Goodwill impairment loss	0	0
Valuation of Long-Lived Assets
Impairment of long-lived assets	0	0
Advertising Expense
Advertising costs	227,000	1,648,000
Convertible debt
Fair Value Measurements
Convertible debt, fair value	$ 20,500,000	$ 20,000,000

Concentrations (Details)

Concentrations (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2020USD ($)bank
Risks and Uncertainties [Abstract]
Number of banks | bank	5
Cash and cash equivalents and restricted cash | $	$ 37,200
Accounts Receivable | One Customer | Customer Concentration Risk
Concentration Risk [Line Items]
Concentration risk, percentage	15.00%

Inventory (Details)

Inventory (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Inventory Disclosure [Abstract]
Raw materials	$ 2,344	$ 2,834
Work in progress	558	532
Finished goods	7,404	5,499
Total inventory, net	10,306	8,865
Inventory impairment	50	$ 162
Consigned inventory	$ 140

Property, Equipment and Right_3

Property, Equipment and Right-of-Use Assets (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Property, Plant and Equipment [Line Items]
Right-of-use assets	$ 4,031	$ 2,890
Property and equipment, gross	17,093	15,744
Less accumulated depreciation	(10,872)	(9,132)
Property, equipment and right-of-use assets	$ 6,221	6,612
Minimum
Property, Plant and Equipment [Line Items]
Depreciable Lives	1 year
Maximum
Property, Plant and Equipment [Line Items]
Depreciable Lives	5 years
Equipment
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 7,452	7,491
Depreciable lives	5 years
Furniture, fixtures and tooling
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 2,156	2,233
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	$ 1,244	1,261
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	$ 1,744	1,671
Leasehold improvements | Minimum
Property, Plant and Equipment [Line Items]
Depreciable lives	3 years
Leasehold improvements | Maximum
Property, Plant and Equipment [Line Items]
Depreciable lives	7 years
Construction in process
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 466	$ 198

Property, Equipment and Right_4

Property, Equipment and Right-of-Use Assets (Lease Narrative) (Details) - USD ($)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Property, Plant and Equipment [Abstract]
Depreciation expense	$ 1,779,000	$ 1,859,000
Impairment charge	0	0
Disposal of property and equipment	405,000
Lease liability	$ 675,000	$ 932,000
Lease liability extensible list	us-gaap:AccountsPayableAndAccruedLiabilitiesCurrent	us-gaap:AccountsPayableAndAccruedLiabilitiesCurrent
Operating lease, liability, noncurrent	$ 2,330,000
Operating lease, liability, noncurrent extensible list	us-gaap:OtherLiabilitiesNoncurrent
Operating lease, payments	$ 1,156,000	$ 1,233,000
Operating lease, weighted average remaining lease term	5 years
Operating lease, weighted average discount rate	8.90%

Property, Equipment and Right_5

Property, Equipment and Right-of-Use Assets (Lease Maturity) (Details) $ in Thousands	Dec. 31, 2020USD ($)
Property, Plant and Equipment [Abstract]
2021	$ 983
2022	566
2023	488
2024	424
2025	404
Thereafter	1,172
Total lease payments	4,037
Less imputed interest	(1,032)
Total operating lease liabilities	$ 3,005

Intangible Assets (Other Intang

Intangible Assets (Other Intangible Assets) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Finite-Lived Intangible Assets [Line Items]
Intangible assets, gross	$ 19,248	$ 19,479
Less accumulated amortization	(13,231)	(11,648)
Total	6,017	7,831
Amortization of intangible assets	$ 1,951	2,201
Customer relationships
Finite-Lived Intangible Assets [Line Items]
Useful life	9 years
Intangible assets, gross	$ 8,301	8,301
Orbera technology
Finite-Lived Intangible Assets [Line Items]
Useful life	12 years
Intangible assets, gross	$ 4,600	4,600
Trade names
Finite-Lived Intangible Assets [Line Items]
Useful life	10 years
Intangible assets, gross	$ 1,700	1,700
Patents and trademarks
Finite-Lived Intangible Assets [Line Items]
Useful life	5 years
Intangible assets, gross	$ 2,597	2,453
Cost incurred to extend and renew patents and trademarks	144	161
Capitalized software
Finite-Lived Intangible Assets [Line Items]
Intangible assets, gross	$ 2,050	$ 2,425
Capitalized software | Minimum
Finite-Lived Intangible Assets [Line Items]
Useful life	1 year
Capitalized software | Maximum
Finite-Lived Intangible Assets [Line Items]
Useful life	5 years

Intangible Assets (Amortization

Intangible Assets (Amortization Expense) (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Goodwill and Intangible Assets Disclosure [Abstract]
2021	$ 1,851
2022	1,674
2023	908
2024	624
2025	564
Thereafter	396
Total	$ 6,017	$ 7,831

Other Assets (Details)

Other Assets (Details) - Surgical Product Line - Disposal - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Noncurrent receivable		$ 2,511
Interest income	$ 416	$ 619
Discount Rate
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Discount rate	10.00%

Accrued Expenses (Details)

Accrued Expenses (Details) - USD ($) $ in Thousands	1 Months Ended	12 Months Ended
	Apr. 30, 2019	Dec. 31, 2020	Dec. 31, 2019
Payables and Accruals [Abstract]
Accrued employee compensation and expenses		$ 3,946	$ 3,183
Lease liability		675	932
Accrued interest		616	467
Accrued professional service fees		358	653
Accrued insurance and taxes		442	271
Accrued returns and rebates		129	216
Settlement liability		0	1,625
Other		1,191	1,091
Total accrued expenses		7,357	8,438
Litigation payment	$ 3,250	1,625
Settlement gain		$ 0	$ 5,609

Long-Term Debt (Schedule of Lon

Long-Term Debt (Schedule of Long-term Debt) (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Mar. 31, 2020	Dec. 31, 2019
Debt Instrument [Line Items]
Deferred financing costs	$ (1,213)		$ (1,068)
Less current portion	(636)		(34,449)
Long-term debt	37,192		0
Deferred interest
Debt Instrument [Line Items]
Long-term debt, gross	1,217		517
PPP loan
Debt Instrument [Line Items]
Long-term debt, gross	2,824	$ 2,824	0
Line of Credit | Term loan facility
Debt Instrument [Line Items]
Long-term debt, gross	$ 35,000		$ 35,000

Long-Term Debt (Narrative) (Det

Long-Term Debt (Narrative) (Details) - USD ($)	Apr. 30, 2020	Mar. 31, 2020	Dec. 31, 2020	Jul. 31, 2020	Mar. 31, 2019	Dec. 31, 2020	Dec. 31, 2019
Debt Instrument [Line Items]
Line of credit			$ 37,824,000			$ 37,824,000
Interest expense						4,212,000	$ 4,579,000
PPP loan
Debt Instrument [Line Items]
Long-term debt, gross		$ 2,824,000	2,824,000			2,824,000	0
Effective percentage		1.00%
Line of Credit | Term loan facility
Debt Instrument [Line Items]
Line of credit					$ 35,000,000
Percent of outstanding amount					7.00%
Commitment fee percentage					5.50%
Twelve month revenue					$ 100,000,000
Increase in minimum liquidity covenant			12,500,000			12,500,000
Long-term debt, gross			$ 35,000,000			$ 35,000,000	$ 35,000,000
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					$ 388,000
Line of Credit | Fifth Amendment
Debt Instrument [Line Items]
Percent of outstanding amount	7.00%	4.90%	5.50%	4.50%

Long-Term Debt (Schedule of Mat

Long-Term Debt (Schedule of Maturity of Long-term Debt) (Details) $ in Thousands	Dec. 31, 2020USD ($)
Debt Disclosure [Abstract]
2021	$ 627
2022	13,550
2023	14,314
2024	9,333
2025	0
Thereafter	0
Total	$ 37,824

Convertible Debt (Schedule of C

Convertible Debt (Schedule of Convertible Debt) (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Debt Instrument [Line Items]
Deferred financing costs	$ (1,213)	$ (1,068)
Long-term debt	37,192	0
Convertible debt
Debt Instrument [Line Items]
Convertible debt principal	20,519	20,000
Deferred financing costs	(1,132)	(1,446)
Long-term debt	$ 19,387	$ 18,554

Convertible Debt (Narrative) (D

Convertible Debt (Narrative) (Details) $ / shares in Units, $ in Thousands	1 Months Ended			12 Months Ended
	Dec. 31, 2020USD ($)shares	Jan. 31, 2020shares	Aug. 31, 2019USD ($)d$ / shares	Dec. 31, 2020USD ($)shares	Dec. 31, 2019USD ($)	Jul. 31, 2020USD ($)
Debt Instrument [Line Items]
Proceeds from convertible debt				$ 0	$ 20,000
Accrued interest	$ 616			616	467
Conversion of convertible debt	$ 81			83
Interest expense				$ 4,212	4,579
Common Stock
Debt Instrument [Line Items]
Convertible securities (shares) | shares	25,528			25,528
Convertible debt
Debt Instrument [Line Items]
Proceeds from convertible debt			$ 20,000
Interest rate			6.00%
Share Price | $ / shares			$ 2.50
Convertible securities (shares) | shares		164,797
Accrued interest	$ 616			$ 616	467
Outstanding interest						$ 600
Interest expense				$ 1,531	$ 588
Convertible debt | Conversion Ratio Less Than 2.50
Debt Instrument [Line Items]
Consecutive trading days | d			10
Convertible debt | Conversion Ratio Of 3.25
Debt Instrument [Line Items]
Consecutive trading days | d			30
Conversion price (USD per share) | $ / shares			$ 3.25
Stock price trigger (USD per share) | $ / shares			$ 9.75
Threshold trading days | d			20

Stockholders' Equity (Authorize

Stockholders' Equity (Authorized Stock) (Details) - $ / shares	Dec. 31, 2020	Dec. 31, 2019
Equity [Abstract]
Preferred and common stock, shares authorized	115,000,000
Common stock, shares authorized (in shares)	100,000,000	100,000,000
Common stock, par value (USD per share)	$ 0.001	$ 0.001
Preferred stock, shares authorized	15,000,000
Preferred stock, par value (USD per share)	$ 0.001

Stockholders' Equity (Warrants)

Stockholders' Equity (Warrants) (Details) - USD ($) $ / shares in Units, $ in Thousands	1 Months Ended
	Jul. 31, 2020	Dec. 31, 2020	Oct. 31, 2020	Dec. 31, 2019
Class of Warrant or Right [Line Items]
Total number of warrants outstanding (shares)		16,617,335
Exercise price (USD per share)		$ 0.24
Number of shares issued in transaction (in shares)	2,480,000
Common stock, par value (USD per share)		$ 0.001		$ 0.001
Sale of stock, price per share (USD per share)	$ 1.25
Warrants to purchase (shares)		0
December 29, 2021
Class of Warrant or Right [Line Items]
Total number of warrants outstanding (shares)		40,456
Exercise price (USD per share)		$ 13.70
February 27, 2022
Class of Warrant or Right [Line Items]
Total number of warrants outstanding (shares)		163,915
Exercise price (USD per share)		$ 21.29
No expiration
Class of Warrant or Right [Line Items]
Total number of warrants outstanding (shares)		16,412,964
Exercise price (USD per share)		$ 0.001
Warrant
Class of Warrant or Right [Line Items]
Warrants to purchase (shares)	17,520,000		2,107,036
Purchase price per warrant (USD per share)	$ 1.249
Proceeds from issuance of warrants	$ 25,000

Stock Option Plans (Plans) (Det

Stock Option Plans (Plans) (Details) - 2017 Plan	12 Months Ended
	Dec. 31, 2020shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percentage of fair value	100.00%
Maximum term of options granted	10 years
Vesting period	5 years
Percentage of outstanding stock	4.00%
Common stock reserved for issuance (in shares)	438,581

Stock Option Plans (Stock Optio

Stock Option Plans (Stock Option Activity) (Details) - Equity Plans - Stock Option - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Options
Options outstanding, beginning balance (in shares)	1,927,194
Options granted (in shares)	1,216,942
Options exercised (in shares)	(5,982)
Options forfeited (in shares)	(216,208)
Options outstanding, ending balance (in shares)	2,921,946	1,927,194
Options exercisable (in shares)	1,364,859
Weighted Average Exercise Price
Weighted average exercise price, beginning balance (in USD per share)	$ 5.01
Options granted (in USD per share)	2.08
Options exercised (in USD per share)	2.31
Options forfeited (in USD per share)	4.13
Weighted average exercise price, ending balance (in USD per share)	3.86	$ 5.01
Options exercisable (in USD per share)	$ 5.17
Weighted Average Remaining Contractual Term
Weighted average remaining contractual term	7 years 7 months 6 days	7 years 6 months
Options exercisable	6 years
Aggregate Intrinsic Value
Aggregate intrinsic value	$ 1,664	$ 87
Options exercisable	$ 143

Stock Option Plans (Fair Value

Stock Option Plans (Fair Value of Stock Options) (Details) - Stock Option	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Risk free interest rate	0.40%	2.20%
Expected dividend yield	0.00%	0.00%
Estimated volatility	73.80%	64.60%
Expected life	5 years 9 months 18 days	6 years

Stock Option Plans (Additional

Stock Option Plans (Additional Information) (Details) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation	$ 2,114	$ 1,487
Stock Option
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation	$ 2,114	$ 1,487
Weighted-average grant date fair value of options granted during the period (USD per share)	$ 1.31	$ 2.08
Aggregate intrinsic value of options exercised during the period	$ 8	$ 20
Unrecognized compensation expense related to unvested options	$ 2,121
Remaining amortization period, less then	2 years
Performance Shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Options granted (in shares)	0

Stock Option Plans (Restricted

Stock Option Plans (Restricted Stock Units Activity) (Details) - Restricted stock units - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Units
Shares outstanding beginning balance (in shares)	243,695
Restricted stock units granted (in shares)	517,978
Restricted stock units vested (in shares)	(85,223)
Restricted stock units forfeited (in shares)	(11,784)
Shares outstanding ending balance (in shares)	664,666
Weighted-Average Grant Date Fair Value
Units outstanding beginning balance (in USD per share)	$ 4.06
Restricted stock units granted (in USD per share)	2.08
Restricted stock units vested (in USD per share)	4.08
Restricted stock units forfeited (in USD per share)	2.08
Units outstanding ending balance (in USD per share)	$ 2.55
Intrinsic value	$ 2,260	$ 695
Compensation not yet recognized	$ 1,251
Remaining amortization period, less then	2 years 2 months 12 days

Commitments and Contingencies (

Commitments and Contingencies (Employment Agreements) (Details)	12 Months Ended
	Dec. 31, 2020
Minimum
Other Commitments [Line Items]
Period for salary and benefits payment	3 months
Maximum
Other Commitments [Line Items]
Period for salary and benefits payment	12 months
Executive Officer
Other Commitments [Line Items]
Period following change in control	12 months
Executive Officer | Minimum
Other Commitments [Line Items]
Period for salary and benefits payment	3 months
Executive Officer | Maximum
Other Commitments [Line Items]
Period for salary and benefits payment	24 months

Defined Contribution Plan (Deta

Defined Contribution Plan (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Retirement Benefits [Abstract]
Cost of defined contribution plan	$ 504	$ 698

Income Taxes (Narrative) (Detai

Income Taxes (Narrative) (Details) - USD ($)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Operating Loss Carryforwards [Line Items]
Income tax expense	$ 142,000	$ 275,000
Valuation allowance - current year	4,194,000	$ 6,820,000
Unrecognized tax benefits	0
Domestic Tax Authority
Operating Loss Carryforwards [Line Items]
Operating loss carryforwards	223,602,000
Operating loss carryforwards, unlimited life	79,764,000
Operating loss carryforwards, reduction due to ownership change	100,825,000
Operating loss carryforwards, net	122,777,000
State and Local Jurisdiction
Operating Loss Carryforwards [Line Items]
Operating loss carryforwards	108,111,000
Foreign Tax Authority
Operating Loss Carryforwards [Line Items]
Operating loss carryforwards	$ 2,382,000

Income Taxes (Deferred Tax Asse

Income Taxes (Deferred Tax Assets Liabilities) (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Deferred tax assets:
Capitalized transaction costs	$ 279	$ 330
Intangible assets	1,100	1,105
Inventory valuation	28	242
Research and development credit	4,123	4,055
Interest expense carryforward	3,121	2,188
Foreign timing differences	578	238
Other	1,095	873
Net operating loss carryforwards	53,666	50,702
Deferred tax assets, gross	63,990	59,733
Deferred tax liabilities:
Unremitted foreign earnings	(463)	(453)
Depreciable assets	(93)	(185)
Total deferred tax liabilities	(556)	(638)
Total net deferred tax assets	63,434	59,095
Less valuation allowance	(63,243)	(59,049)
Net deferred tax assets (included in other assets)	$ 191	$ 46

Income Taxes (Effective Income

Income Taxes (Effective Income Tax Rate) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Income Tax Disclosure [Abstract]
Tax at U.S. statutory rate	$ (4,719)	$ (5,703)
State taxes, net of deferred benefit	(536)	(1,051)
Foreign tax rate differential	(327)	(330)
Foreign taxes	(13)	22
Permanent differences	702	442
Research and development tax credit	(313)	(408)
Other	365	478
Deferred tax adjustment	756	(1)
Unremitted foreign earnings	33	6
Valuation allowance - current year	4,194	6,820
Income tax expense	$ 142	$ 275

Income Taxes (Income Tax Expens

Income Taxes (Income Tax Expense) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Current taxes:
U.S. state	$ 11	$ 0
International	279	321
Total current income tax expense	290	321
Deferred taxes:
International	(148)	(46)
Total deferred income tax expense	(148)	(46)
Income tax expense	$ 142	$ 275

Net Loss Per Share (Details)

Net Loss Per Share (Details) - shares	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of diluted loss per share	17,386,901	4,900,794
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	8,068,615	590,672
Convertible debt
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of diluted loss per share	6,310,621	2,440,904
Common stock options
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of diluted loss per share	2,520,029	1,699,410
Restricted stock units
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of diluted loss per share	487,636	169,808

Segment and Geographic Inform_3

Segment and Geographic Information (Segment Information) (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2020USD ($)segment	Dec. 31, 2019USD ($)
Revenue, Major Customer [Line Items]
Number of reportable segments | segment	1
Revenues	$ 42,048	$ 50,713
U.S.
Revenue, Major Customer [Line Items]
Revenues	22,272	21,921
Other
Revenue, Major Customer [Line Items]
Revenues	$ 19,776	$ 28,792
Revenue | Product Risk
Revenue, Major Customer [Line Items]
Percentage of total revenue	100.00%	100.00%
Revenue | Product Risk | U.S.
Revenue, Major Customer [Line Items]
Percentage of total revenue	53.00%	43.20%
Revenue | Product Risk | Other
Revenue, Major Customer [Line Items]
Percentage of total revenue	47.00%	56.80%
Distributor Sales | Product Risk | Other
Revenue, Major Customer [Line Items]
Percentage of total revenue	35.20%	33.90%
Distributor Sales | Product Risk | Non US Next Largest Single Country
Revenue, Major Customer [Line Items]
Percentage of total revenue	7.60%	7.60%
ESS
Revenue, Major Customer [Line Items]
Revenues	$ 25,729	$ 28,309
ESS | U.S.
Revenue, Major Customer [Line Items]
Revenues	15,774	14,944
ESS | Other
Revenue, Major Customer [Line Items]
Revenues	$ 9,955	$ 13,365
ESS | Revenue | Product Risk
Revenue, Major Customer [Line Items]
Percentage of total revenue	61.20%	55.80%
IGB
Revenue, Major Customer [Line Items]
Revenues	$ 14,784	$ 16,840
IGB | U.S.
Revenue, Major Customer [Line Items]
Revenues	5,045	5,162
IGB | Other
Revenue, Major Customer [Line Items]
Revenues	$ 9,739	$ 11,678
IGB | Revenue | Product Risk
Revenue, Major Customer [Line Items]
Percentage of total revenue	35.20%	33.20%
Total Endoscopy
Revenue, Major Customer [Line Items]
Revenues	$ 40,513	$ 45,149
Total Endoscopy | U.S.
Revenue, Major Customer [Line Items]
Revenues	20,819	20,106
Total Endoscopy | Other
Revenue, Major Customer [Line Items]
Revenues	$ 19,694	$ 25,043
Total Endoscopy | Revenue | Product Risk
Revenue, Major Customer [Line Items]
Percentage of total revenue	96.40%	89.00%
Surgical
Revenue, Major Customer [Line Items]
Revenues	$ 0	$ 3,712
Surgical | U.S.
Revenue, Major Customer [Line Items]
Revenues	0	0
Surgical | Other
Revenue, Major Customer [Line Items]
Revenues	$ 0	$ 3,712
Surgical | Revenue | Product Risk
Revenue, Major Customer [Line Items]
Percentage of total revenue	0.00%	7.30%
Other
Revenue, Major Customer [Line Items]
Revenues	$ 1,535	$ 1,852
Other | U.S.
Revenue, Major Customer [Line Items]
Revenues	1,453	1,815
Other | Other
Revenue, Major Customer [Line Items]
Revenues	$ 82	$ 37
Other | Revenue | Product Risk
Revenue, Major Customer [Line Items]
Percentage of total revenue	3.60%	3.70%

Segment and Geographic Inform_4

Segment and Geographic Information (Long-Lived Assets by Geographic Area) (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Revenues from External Customers and Long-Lived Assets [Line Items]
Total property and equipment, net	$ 6,221	$ 6,612
U.S.
Revenues from External Customers and Long-Lived Assets [Line Items]
Total property and equipment, net	2,149	2,934
Costa Rica
Revenues from External Customers and Long-Lived Assets [Line Items]
Total property and equipment, net	3,641	3,039
Other
Revenues from External Customers and Long-Lived Assets [Line Items]
Total property and equipment, net	$ 431	$ 639

Uncategorized Items - apen-2020

Label	Element	Value
Accounting Standards Update [Extensible List]	us-gaap_AccountingStandardsUpdateExtensibleList	us-gaap:AccountingStandardsUpdate201602Member