© 2019 Over the last 20 years, a large proportion of research in the field of gastroenterology has focused on improving endoscopic imaging and developing minimally invasive therapy for benign and malignant conditions. Both conceptually and practically, these avenues advance concomitantly: refinement of endoscopic imaging leads to earlier diagnosis, and a growing number of endoscopic treatment modalities can be offered. In addition, preventive medicine has triggered studies on the natural history of premalignant conditions, aiming to define the boundaries for early therapeutic intervention. Endoscopic therapy plays a key role in the treatment of pre-cancerous and early cancerous conditions of the gastrointestinal (GI) tract, for which it has been increasingly replacing conventional surgical approaches, with improved tolerability and comparable or better outcomes. Simultaneously, the rising global burden of obesity and its complications has opened a new interventional area in endoscopy. Endoscopic approaches for the treatment of obesity, gastro-oesophageal reflux disease and diabetes have emerged in recent years. In this review, novel GI procedures for the diagnosis and treatment of common GI or GI-related conditions are illustrated. These are at different stages of introduction into routine practice but are likely to have a significant impact on patient management in the near future.