<p>The Japan Society for Treatment of Obesity has repeated nationwide surveys on bariatric/metabolic procedures, including endoluminal procedures. We report the changes from 2021 to 2024. An e-mail survey was sent to 108 Japanese institutions that performed the bariatric/metabolic procedures. The number of laparoscopic bariatric/metabolic surgeries was as follows: 2021 (<i>n</i> = 890), 2022 (<i>n</i> = 985), 2023 (<i>n</i> = 936), and 2024 (<i>n</i> = 915). The number of laparoscopic sleeve gastrectomy (LSG) with bypass procedures increased in 2024 according to insurance coverage. Additionally, the number of LSGs for body mass index (BMI) &lt; 35&#xa0;kg/m² drastically increased in 2024 according to changes in insurance coverage. The number of endoluminal bariatric/metabolic procedures was as follows: 2021 (<i>n</i> = 40), 2022 (<i>n</i> = 51), 2023 (<i>n</i> = 72), and 2024 (<i>n</i> = 80). Intragastric balloon placement and endoscopic sleeve gastroplasty were performed. The proportions reversed over four years. In Japan, the number of LSG with bypass procedures and LSGs for BMI &lt; 35&#xa0;kg/m² is expected to increase in the future.</p>