Enhanced attention to the problem of Barrett’s oesophagus as a premalignant condition predisposing to oesophageal adenocarcinoma is due to the ever growing frequency of this co-morbid pathology. The continuing rise in the incidence of adenocarcinoma of the esophagus has resulted in its almost fivefold increase during the past 20 years in the USA and the Western Europe. Adenocarcinoma currently accounts for more than 50% of all oesophageal cancers in this country. The prevention and early diagnostics of oesophageal adenocarcinoma imply the necessity of the timely detection and adequate treatment of Barrett’s oesophagus which is known to be one of the most serious complications of gastroesophageal reflux disease (GERD) characterized by the strong tumorigenic potential. The poor survival rates among the patients presenting with adenocarcinoma of the oesophagus are significantly improved by early tumor detection. Therefore, it is important to identify absolute high-risk subjects for whom endoscopic screening or surveillance might be warranted. In accordance with the latest European guidelines, the diagnosis of Barrett’s oesophagus is made when endoscopic and morphological studies reveal in the distal portion of the oesophagus (proximal to the gastrooesophageal junction) a segment of specialized intestinal metaplasia formed by columnar epithelium as long as at least 1 cm exhibiting goblet cells upon the histopathological examination. Thus, the high-quality investigations (endoscopic and morphological) provide a basis for reliable diagnostics of Barrett’s oesophagus. Nevertheless, many uncertainties concerning this condition remain. For example, the specific cause or causes of metaplasia and the development of neoplasia are still unknown, the risk of cancer for the individual patients needs to be evaluated, the role and peculiarities of screening and surveillance must be elucidated, and the ideal approaches to the clinical management of Barrett’s oesophagus with concomitant oesophageal adenocarcinoma should be found. However, in the face of these uncertainties, the clinicians still have to make decisions concerning individual patient on a daily basis. It is believed that the use of the new endoscopic techniques will make it possible for a properly trained specialist to early identify the minute structural changes in the mucous membrane lining the distal portion of the oesophagus and thereby to enhance the effectiveness of the long-term follow-up of individual patients. The reliable detection of neoplasia has been promoted by the availability of the new imaging modalities, such as high-resolution endoscopy, narrow-band imaging, and high-magnification endoscopy. It is concluded that the wider application of the up-to-date endoscopic therapeutic modalities in the routine clinical practice for the treatment of high-grade dysplasia and early oesophageal adenocarcinoma as well as for ablation of the segment of specialized intestinal metaplasia formed by columnar epithelium or dysplasia of the distal portion of the oesophagus will contribute, in the future, to the significant reduction in the risk of development of oesophageal adenocarcinoma associated with Barrett’s oesophagus.