This paper was originally presented as part of the SSAT/SAGES Joint Symposium, The Endoscope as a Surgical Tool: Foregut, at the SSAT 50th Annual Meeting, June 2009, in Chicago, Illinois. The other articles presented in the symposium were Nieponice A and Jobe BA, Endoscopic Fundoplication: Real or Fantasy?, and Rattner DW and Gee DW, Transmediastinal Endoscopic Intervention.