Over the past 20 years, flexible endoscopy has evolved from a primarily diagnostic endeavor to one of the most rapidly growing fields of therapeutic surgery. Multitudes of techniques and technologies have been developed to treat a wide spectrum of gastrointestinal diseases. Endoscopic suturing, radiofrequency energy delivery, mucosal resection, and thermal ablative techniques are among the most promising modalities in the field. Furthermore, the development of endoscopic transgastric surgery opens the door to a variety of novel intraluminal procedures. Though the ultimate role of these innovations is yet to be determined, the future of feasible surgical endoscopy holds great potential.