Barrett’s esophagus (BE) is characterized by a change from normal squamous epithelium to metaplastic columnar epithelium. BE is prone to neoplastic change and is a known precursor of esophageal adenocarcinoma. Regular surveillance and surgical resection were used to be the only available strategies for the management of Barrett’s neoplasia. With advancement of technology, especially in endoscopy, a more accurate assessment of BE is possible. Systemic biopsy or with the help from chromoendoscopy, targeted biopsy may increase the diagnostic yield of BE. In high volume center with a specialized unit dedicated for esophageal disease have advantages in appropriate patient selection, formulation of therapeutic strategy and application of proper treatment modalities. For dysplastic changes and early adenocarcinoma, endoscopic resection of ablation has been shown to have a similar efficacy when compared to radical surgical resection. When lesions invaded to the submucosal layer, the incidence of occult nodal metastases is unacceptably high. In such situation, minimally invasive surgical approach incorporated with dedicated perioperative care such as enhanced recovery after surgery programs may improve the outcomes.