To date, diet programs and medical therapies for the treatment of obesity have had limited success. Bariatric surgery, however, provides a means of effective weight loss for many of those with morbid obesity. Most of these weight loss procedures are performed with a variety of techniques that continue to evolve. Each technique is associated with unique challenges and complications and it is important for the clinician to be knowledgeable about the endoscopic management of these patients. Additionally, as endoscopic technology evolves it may offer more than just the diagnosis and treatment of complications.