With the development of flexible instruments, devices that allows the surgeons to operate from within the stomach are now available.  

The EsophX device allow us to suture within the stomach in such a way that we can strenghten the valve between the esophagus and the stomach to reduce acid reflux.

Other suturing devices such as the StomaphyX or the Expandable Tissue Anchors from USGI medical are used to revise patients that have undergone Roux-en-Y gastric bypass and the allows to reduce and revise gastric bypass pouches and stomas.