Endoscopy provides an accurate method for diagnosis of esophageal carcinoma. Strategies for surveillance of patients with Barrett's esophagus by endoscopic biopsy are available and will hopefully improve our ability to diagnose early stage adenocarcinoma. No well-defined high-risk group for squamous cell carcinoma exists that would justify routine endoscopic surveillance. Careful attention should be paid to subtle changes in mucosal topography and color, which may suggest early squamous carcinoma in older patients undergoing diagnostic endoscopy. Further research is necessary to define what role if any vital dye staining has in screening of patients in the United States for esophageal cancer.