Background: Throughout the last decade, the treatment of obesity has slowly undergone a paradigm shift. The advent of endoscopic balloon therapy has had a profound impact on long-term weight management. Endoscopic balloons have been used to treat obese patients seeking weight loss. Objective: To evaluate the safety and effectiveness of intra gastric balloon compared to gastric bypass surgery as the standard of care. Patients and methods: This study included 30 obese patients fit for endoscopic treatment by intragastric balloon (BMI equal or more than 35) and 15 diabetic patients fit for Mini gastric bypass BMI > 35kg/m2. Their ages ranged 18 - 45 years. All balloons were done in private center (Masrscope Endoscopy Center) in Cairo. Mini gastric bypass operations were done in Aldemerdash Hospital during period from March 2016 till September 2016. Results: Age was 18-45 years (60% females). Initial body mass index (BMI) was 35-43 kg/m2. Three early removals were encountered due to intolerance. BMI reduction ranged 15-40% at balloon removal after 6 months and 25-50% after mini gastric bypass. Metabolic profile improved in all patients. Eighty percent of patients were satisfied with the balloon and 50% with mini gastric bypass. Conclusion: After 6 months following surgery, the small gastric bypass resulted in a considerable weight loss. There were few problems, excellent safety, and substantial efficacy when treating obese individuals with balloon implantation. Even before a scheduled bariatric surgical treatment, endoscopic intra gastric balloon implantation is an effective and safe technique of reducing extra body mass in obese individuals.