Barrett's esophagus is the premalignant lesion for esophageal and esophagogastric junction adenocarcinoma. Progression of Barrett's esophagus to dysplasia and cancer can occur, thus requiring endoscopy with random biopsy examinations. Currently, the diagnosis of metaplastic and dysplastic mucosa within the esophagus requires endoscopy with biopsy examination of abnormal-appearing tissue. The presence of intestinal metaplasia and dysplasia within the esophagus often is patchy, and our current practices of performing standard endoscopy with random biopsy examinations are inaccurate. Narrow band imaging is among several tools used in the esophagus to improve detection of Barrett's esophagus and associated dysplasia. Current studies show that these techniques are promising, although the results still are preliminary.