|Bariatric surgery currently the most powerful ammunition for obesity. In Asia, the number of bariatric surgeries has increased significantly in the past few years. However, less than 1% of obese population accept surgery due to risk. There is a need of effective but safer therapy. In recent years, bariatric endoscopy becomes a new specialty which provide primary endo-therapy for obesity & diabetes. With more understanding of the pathophysiological change after bariatric surgery, new endoscopic treatment are evolving. These procedures try to mimic the change after surgery and the target organ include both stomach and small intestine. Gastric procedures include intragastric gastric balloon (IGB）placement, endoscopic gastroplasty and aspiration therapy. IGB is an effective but temporary device that only last for 6-12 months. With technological advancement in endoscopic full-thickness plication (POSE）and suturing (Overstitch）, endoluminal gastroplasty develop as a hope for long-term weight management. Gastric aspiration therapy (Aspire-Assist）is another development for patients willing to empty stomach after each meal. On the other hand, small bowel intervention like Duodenojejunal Bypass Liner (EndoBarrier）and Duodenal Mucosal Resurfacing (DMR）mimic duodenal exclusion after gastric bypass, which can altered gut hormone production and improve glycemic control. More recently, with the use of endoluminal magnet (GI Window）, anastomosis can be created between two endoscope and provide an exciting option of gastrointestinal bypass. However, more clinical evidences are need to proof its safety and effectiveness.