Introduction: Although rare, bariatric surgery can be associated with significant gastrointestinal complications such as leaks at the anastomotic site, strictures, ulcers and fistulas. Due to the distorted anatomy and associated morbidities, surgical re-intervention is associated with a high morbidity. Thus, for these patients, endoscopic procedures may be a more suitable and perhaps the first attempted therapeutic option. As endoscopic techniques expand, such complications are more readily being treated with devices including self-expanding metal stents, endosuturing device and the OTSC (Over-The-Scope Clip) system. We aim to evaluate the success, safety and complications rates of endoscopy for the management of bariatric surgery complications. Methods: A retrospective, observational cohort study at a single academic institution during an 18-month period evaluating patients with complex post-bariatric surgery complications. Anastomotic stenosis were excluded from this study. Results: During the study period we treated a total of 14 patients (mean age 52 years; 7 male, 7 female). The complications were laparoscopic band migration into the stomach, fistulas, abscess, leaks, stenosis, sleeve perforation and GI bleeding. The surgeries included: Roux-en-Y gastric bypass surgery (RYGB)(n=3), gastric sleeve (n=5), lap band or mesh migration (n=4), (n=1), bile leak after liver transplant in RYGB (n=1), gastro-gastric fistula (n=1). The mean follow-up was 20 weeks. The most common device used to treat complications was the OTSC, which was used in several cases including fistula repair(n=6) or bleeding ulcers(n=2). Treatment with hemoclips was also used for ulcer(n=1) and fistula(n=1). Two patients underwent stent placement for sleeve fistula and stenosis. Four patients underwent placement of a direct endoscopic jejunostomy (DPEJ) using double balloon enteorscopy. Most patients required repeated endoscopies (range 1-7, mean 3.8 procedures) to treat their complication. Endoscopy led to a full resolution of the primary problem in 50% of patients, partial resolution in 25% and no resolution in 25%. Conclusion: Although uncommon, gastrointestinal complications associated with bariatric surgery tend to be very complex. These endoluminal conditions often require specialized endoscopic treatment, which results in resolution of the problem in about 50% of patients, therefore representing a valid alternative for treatment. However, some luminal defects associated with these types of surgery are recalcitrant to endoscopic approaches and require definitive surgical intervention to solve the problem; Nevertheless, endoscopy can serve as a bridge to surgery, to provide enteral feeding, thus decreasing the size of GI defect and improving the patient’s general status.