 Barretts esophagus BE is defined as a change in the esophageal mucosa from normal squamous epithelium to columnar epithelium with intestinal metaplasia 1. There is compelling evidence that BE is a precursor lesion for adenocarcinoma of the esophagus 2. There is also evidence that the prevalence of BE is much higher than was initially suspected, and that the true incidence rate of cancer in patients with BE is much lower than previously estimated. Endoscopic surveillance of all patients with BE is not likely to be cost effective, or save many lives. Therefore, it is important to understand which patients with BE are likely to progress to malignancy, and equally important to determine which patients are not likely to progress.Because progression is an uncommon event, definitive studies of natural history including evaluation of numerous risk factors require large numbers of patients, that can only be accomplished in the context of a multicenter study. This model will be a useful tool leading to a reduction in overall health care costs. 