After a hiatus of 30 years an attempt is now being made to re-assess the previously reported very high esophageal cancer incidence rates in the Caspian Littoral. The extraordinarily high incidence rates found in the eastern side of the Littoral, were re-confirmed five years ago for the Turkoman region, using esophageal balloon cytology supplemented by esophagoscopy of suspected cases. The focus this time was on the Ardabil province in the western side of the Caspian Littoral, where the rates reported 30 years ago were moderately high. A pilot chromoendoscopic screening program was scheduled for 650 asymptomatic adults from a randomly selected part of the city of Ardabil and adjoining villages, to evaluate the overall patterns of esophageal disease and to establish the utility of endoscopy as an esophageal cancer screening tool. 504 healthy volunteers, giving a compliance rate of 77.5%, submitted to esophagogastroscopy without any mishaps. Contrary to expectation, no dysplasia or esophageal cancer was found in 914 satisfactory biopsy specimens. Total absence of esophageal cancer or precursor dysplastic changes in the surveyed population in the western part of the Caspian Littoral was at variance with the cancer registry findings of three decades ago for the western part of the Littoral. A plausible explanation could be the improved socio-economic conditions and life style changes which have taken place in the recent past all along the Caspian Littoral, except in the Turkoman Plain.