Between 1980 and 1993, out of 635 patients presenting with an adenocarcinoma of the esophagogastric junction, 74 (11.7%) had a neoplasm arising from a columnar specialized epithelium lining the distal esophagus. Fifty of these patients (68%) underwent a curative (R0) resection. 36 patients (72%) were in stage 0, I or II, and the 5-year actuarial survival rate was 44%. The survival rate dropped to 13% when nodal metastases were present. We conclude that the long-lasting symptoms during the pre-neoplastic phase, and a closer endoscopic surveillance allow a early diagnosis of Barrett adenocarcinoma. Surgical therapy must be radical in these patients in order to improve prognosis.