Barrett’s oesophagus carries an annual risk of developing cancer. We reviewed the literature looking for best evidence papers addressing the management of early oesophageal cancer. A total of 510 papers were found using the reported searches. Oesophagectomy and lymph node dissection for early oesophageal cancer is the standard to which every other treatment modality is compared to. However, the associated mortality and morbidity rates highlight the need for alternative effective and less invasive procedures. Despite the fast growing interest in Minimally invasive oesophagectomy, there is no way to compare it to endoscopic treatment in terms of impact on patient. The evidence from the present review supports the following : Endoscopic resection (ER) and Radiofrequency Ablation (RFA) should be regarded as the first line treatment in T1a oesophageal cancer. The trade off for Endoscopic treatment is a higher recurrence rate which can be dealt with using a strict follow up and retreatment. The higher rates of lymph nodes involvement in T1b cancers preclude the use of endoscopic treatment in this setting except for patients unfit for surgery. G3, Vascular and lymphatic invasion are prognostic factors for lymph node involvement.