Barrett’s oesophagus is an acquired metaplastic condition that predisposes patients to the development of oesophageal adenocarcinoma, prompting the use of surveillance regimes to detect early malignancy for endoscopic therapy with curative intent. The currently accepted surveillance regime uses white light endoscopy together with random biopsies, but suffers poor sensitivity and discards information from numerous light-tissue interactions that could be exploited to probe structural, functional and molecular changes in the tissue. Advanced optical methods are now emerging that are exquisitely sensitive to these changes and hold significant potential to improve surveillance of Barrett’s oesophagus if they can be applied endoscopically. The next decade will see some of these exciting new methods applied to Barrett’s surveillance in new device architectures for the first time, potentially leading to a longawaited improvement of the standard of care.