The incidence of esophageal adenocarcinoma is on the rise. With advances in endoscopic techniques and imaging technology, early neoplastic lesions are being increasingly detected and treated. Managing early esophageal adenocarcinoma with endoscopic techniques is now considered the cornerstone of therapy, offering an alternative to surgery. The available endoscopic techniques can be broadly categorized into resection and ablation techniques that may be combined to increase the effectiveness of therapy. However, endoscopic treatments are highly specialized and patients with early adenocarcinoma should be referred to centers with expertise in advanced endoscopy of the esophagus. We review the proper method for conducting a thorough evaluation of early neoplastic lesions, staging details, the available endoscopic resection and ablation techniques, and the efficacy and safety of different endoscopic treatments.