Restrictive, Malabsorptive and others [12]. Restrictive procedures act by decreasing the gastric volume by space-occupying devices and/or by suturing or stapling techniques, whereas malabsorptive procedures tend to create malabsorption by preventing the food contact with the duodenum and proximal jejunum [12]. Malabsorptive procedure mimics Roux-n-Y gastric bypass (RYGB) surgery. RYGB exhibits significant hormonal changes after surgery which results in acute and immediate glycemic control via an anti-diabetic weight-independent mechanism, even without significant weight loss after surgery. Therefore, malabsorptive procedure can be considered metabolic procedure because it will help in reducing weight as well as type 2 diabetes mellitus (T2DM). In this review article, we aim to provide an overview on the role of small intestine on obesity and metabolic syndrome and different newer Endo Bariatric procedure focusing on small intestine. Pathophysiology of Small Intestine in the Obesity and T2DM It is very important to understand the role of small intestine in the pathophysiology of obesity in order to understand the effective treatment or endoscopic procedures. Recent insights have revealed the critical physiologic and pathophysiologic role of the small bowel in metabolic homeostasis and its potential role as a driver of obesity, insulin resistance, and subsequent T2DM