The development of flexible endoscopic instruments has altered the surgical approach to many disease processes. Endoscopic treatment of gastrointestinal polyps, common bile duct stones and foreign bodies of the gastrointestinal tract has now become the preferred method of treatment. Endoscopic gastrostomy is replacing surgical gastrostomy for the patient who requires long term enteral nutrition. Sclerosis of esophageal varices has now become the preferred method of managing patients with portal hypertension and bleeding esophageal varices. As newer endoscopic instruments are developed, more and more operative procedures will be carried out by endoscopic methods.