Purpose: Endoscopic modalities including EMR are increasingly being used in patients with Barrett's esophagus and dysplasia or early cancer who are either at high-risk for surgery or who refuse this invasive option. We reviewed our clinical experience in patients who underwent EMR for superficial cancer or dysplasia in the setting of Barrett's esophagus. Methods: We performed a retrospective review of a prospectively collected database of all patients who underwent EMR at the University of Chicago for any indication between November, 2001 to June, 2004. Patients who had EMR for dysplasia or early cancer of the esophagus or gastroesophageal junction in the setting of Barrett's were identified. Clinical parameters including patient age, American Society of Anesthesia (ASA) class, indication forprocedure, complications, length of follow-up, othertreatment modalities utilized, morbidity and mortality, and other parameters were recorded. Results: Nineteen procedures were performed in 14 patients with documented Barrett's with either dysplasia or superficial cancer, including 12 males and 2 females. The mean patient age was 67, ASA class 2.5, and number of procedures per patient was 1.4. Mean follow-up was 104 days. 11/14 patients had EUS staging prior to EMR. EMR technique included lift and cut 8/19, free-hand without submucosal injection 10/19, and cap 1/19. 6 patients underwent hemi-circumferential EMR to obliterate all abnormal tissue, while 8 had resection of nodules or abnormal appearing lesions. 10 patients had biopsies consistent with or highly suspicious for adenocarcinoma, 3 had HGD and 1 had LGD. There were no immediate complications. Long-term complications included esophageal stricture in one patient. Margins were free of dysplasia or cancer in 7, positive in 5 and indeterminate in 2. No patients progressed from HGD to cancer during the follow-up period. 8 patients had no HGD on most recent endoscopy, 3 underwent surgery, 2 were lost to follow-up, 1 had chemo-radiation and 1 died of unrelated causes. Conclusions: EMR is a safe and viable alternative for treatment of patients with high-grade dysplasia or early esophageal adenocarcinoma who are either high risk for surgery or who refuse this invasive management option.