Situs inversus is an anatomical rare condition in which visceral organs are not located in its normal position, with a reversal anatomical orientation. We present a case of an 27-year-old male with a Body Mass Index (BMI) of 36.02 Kg/m2, who was programed for a Endoscopic Sleeve Gastroplasty (ESG), in which Situs inversus was documented. Situs inversus is an uncommon anatomical condition that complicates identifying surgical landmarks and performing procedures like ESG. Preoperative imaging, such as abdominal ultrasound or computed tomography, is critical for confirming the diagnosis and planning the intervention. In this case, ESG was successfully executed using standard techniques, emphasizing the importance of expertise and careful planning. The reversed anatomy required adjustments in endoscopic navigation but did not necessitate major deviations from established protocols. This case highlights that, under the care of experienced endoscopists, ESG remains a safe and effective option for patients with situs inversus. Situs inversus is rare anatomical variation that can represent a challenge in bariatric endoscopic procedures such as ESG. Nevertheless, ESG can be safely performed under an experienced endoscopic bariatric surgeon.