Experimental evidence demonstrates that intestinal bypass surgery has direct effects on glucose metabolism, highlighting the importance of the small intestine, particularly the duodenum, in the physiology and pathophysiology of glucose homeostasis . Observations in animal models and humans reveal that the duodenal mucosa exhibits abnormal hypertrophy and endocrine hyperplasia in the presence of diabetes. More specifically, exclusion of nutrient contact from the duodenal surface in type 2 diabetes may elicit beneficial downstream effects on metabolism, perhaps through the reduction of putative anti-incretin mechanisms. Duodenal mucosal resurfacing (DMR) is a novel, minimally invasive, catheter-based upper endoscopic procedure involving hydrothermal ablation of the duodenal mucosa and subsequent mucosal healing. DMR may offer a new treatment approach for type 2 diabetes by altering the duodenal mucosal surface itself, thereby altering downstream signaling and eliciting metabolic improvement. In this lecture Dr Galvao Neto describes the DMR technique and its preliminary results.