 Patients with Barretts esophagus are advised to undergo periodic endoscopic surveillance with random biopsies in an attempt to identify high-grade dysplasia HGD or early adenocarcinoma ACA at a time when intervention can be curative. This approach, however, can be time-consuming and is hindered by low sampling yield and random sampling error. Endoscopic Tri-Modal Imaging ETMI is a novel diagnostic modality that encompasses three advanced imaging features in one system: high-resolution endoscopy HRE, autofluorescence imaging AFI and narrow-band imaging NBI. HRE and AFI provide a birds-eye view of red flag areas which are then assessed by NBI for focused and more specific tissue characterization. The aim of this prospective, multi-center study is to compare the diagnostic performance of ETMI with that of standard white-light endoscopy WLE for identifying high-grade dysplasia HGD and early adenocarcinoma ACA in BE. A total of 84 BE patients will be recruited for the study and they will undergo both ETMI and WLE examinations in a randomized, crossover fashion. Standard surveillance biopsies and ETMI-targeted biopsies will be performed. The primary outcome will compare the number of patients and lesions with HGD or early ACA detected with WLE and ETMI. It is anticipated that ETMI will enhance the detection of high-grade Barretts lesions relative to WLE. 