Therapeutic and advanced endoscopy has transformed the management of many gastrointestinal conditions by offering minimally invasive alternatives to surgery. Techniques such as endoscopic mucosal resection, submucosal dissection, full-thickness resection, and advanced biliary and pancreatic interventions allow effective treatment of complex lesions. Endoscopic closure devices, stenting technologies, and hemostatic tools have expanded therapeutic capabilities. Continuous innovation in equipment, imaging, and accessories has improved procedural safety and efficacy. Operator expertise, structured training, and multidisciplinary collaboration are essential for successful outcomes. As indications broaden, patient selection and risk stratification remain critical. This topic explores advances in therapeutic endoscopy, procedural outcomes, training standards, and the expanding role of endoscopy in comprehensive gastrointestinal care.