Background: Conventional approaches in the management of obesity offer only a limited potential for sustained weight loss. Moreover, bariatric surgery, although momentarily being the most effective weight-loss treatment, has some serious pitfalls, such as significant morbidity rate, high substantial costs and limited patient applicability. Hence, there is a substantial need for endoscopic approaches to obesity. Summary: The aim of this article is to provide a historical overview of bariatric endoscopy in the management of obesity; moreover to selectively review and evaluate the currently available endoscopic weight-loss techniques and devices, and third to identify new directions and future prospects in this rapidly advancing field. Key Messages: Bariatric endoscopy procedures efficiently replicate some of the anatomical features and the physiological effects of the traditional weight-loss surgical approaches, while at the same time being more applicable, entirely reversible, less-invasive, safer and more cost effective. Endoscopic modalities in the treatment of obesity can be categorized into the following: restrictive procedures, malabsorptive procedures, gastric function/emptying regulation, gastric aspiration, and so on. To conclude, it is of high importance to constantly evaluate the long-term efficacy and safety of new endoscopic weight-loss techniques and devices, based on evidencebased medicine principles.