My approach systematically begins with counseling patients on all options of therapy and confirming the diagnosis of dysplasia with our gastrointestinal pathologists. I treat patients with high dose proton pump inhibitors twice daily. I standardly begin with a thorough endoscopic evaluation followed by endoscopic therapy. I utilize advanced imaging modalities that include narrow band imaging and/or confocal laser endomicroscopy to enhance my endoscopic examination to improve my diagnostic yield for biopsies and resections. Treatment for patients with high-grade dysplasia first begins with focal endoscopic mucosal resection of any visible lesions. Then, I treat the remainder of Barrett’s mucosa radiofrequency ablation. Long segments are first treated with circumferential RFA with the balloon device. I treat shorter segments and residual areas with focal RFA. After treatment is completed, I perform surveillance endoscopies with biopsies yearly. I prepare patients with the knowledge that endoscopic treatment may require multiple modalities, multiple sessions, and indefinite surveillance.