Increased population longevity as well as an emphasis on earlier diagnosis and more effective treatment of cancer have created an environment for new technologies and techniques to flourish. Some of the endoscopic entities discussed in this article have not been fully validated in clinical practice. Innovative spectroscopic modalities hold a great deal of promise, but are years away from general applicability. In contrast, many interventional endoscopic techniques are currently available and confer heightened levels of diagnostic and staging accuracy for gastric and esophageal malignancies. Earlier diagnosis can identify patients who may be eligible for less-invasive treatment options such as EMR. Minimally invasive treatment options and maximum staging accuracy are more important for patients who are marginal surgical candidates and for accurate comparison of clinical trials studying treatment options. Our challenge for the future is to properly integrate these technologic advances with the science of good medical practice.