Interactions of heat transfer enhancement and fouling can occur due the change in nature of the surface, operating condition, or the fluid itself. Interactions arising relating to higher clean heat transfer coefficients, and higher wall shear stresses of the enhanced surfaces are discussed in this paper. On the lab-scale, enhancement was often achieved by static elements, such as wire wrapping on a heated rod in an annular flow. Lab-scale tests of necessity suffered from effects of relatively short duration of runs, and re-circulation of a batch of liquid with the danger of changing the fluid composition during experiment. Nevertheless, initial fouling rate results consistent with expected trends could be achieved for hydrocarbon fouling, and particulate fouling. There is a continued need to better represent and compare performance of plain and enhanced surfaces over prolonged operating periods in industrial heat exchangers, using commercial enhancement technologies. Example case studies are discussed which demand different methods of comparing performances. A daily averaged cost analysis is identified as a possible systematic approach on the evaluation of the economic benefit of the use of enhancement devices. This is illustrated for a case study example where tube insert is used as an enhancement option.