New technologies arrive every day in the field of bariatrics, since obesity is the late twentieth-century epidemic. The place where traditional bariatric surgery stands is well known, but even though it is a safe approach, it continues to be a surgical intervention with some degree of morbidity. Another issue with such procedures is that less than 1% of people requiring surgery are getting it. Newer techniques, such as endoscopic therapies, open a new horizon to try to reach more patients with lower costs and less morbidity, without competing directly to bariatric surgery. The endoscopic sleeve gastroplasty has shown promising results in short-term studies, with extremely low morbidity. This technique requires a learning curve and aims to narrow the gastric lumen without surgery (“endosleeve”). Weight loss after 18–24 months has been described in around 15–18% of total body weight loss. Patients with poor response (measured during the first 6 months) will eventually fail, and prompt reevaluation is recommended, where a re-endoscopic sleeve gastroplasty or a bariatric surgery can be offered. Conversion to a sleeve gastrectomy is feasible, since most of the times the sutures and clinches are not in place, allowing a safe stapler positioning. An endoscopy before surgery is mandatory, as well as during the procedure if sutures remain in place. Is recommended the removal of the sutures (if possible) with an endoscopy before dividing the stomach. The incisura is an important landmark, so if this area cannot be securely liberated from sutures and divided, a gastric bypass should be considered. Close follow-up during the first 48 hours and radiologic studies are advised during the first cases. There are no studies that show the outcomes of patients revised to sleeve of gastric bypass.