We reviewed our experience with patients with symptoms of dysphagia to determine whether endoscopy increased the chance of finding esophageal carcinoma when barium studies of the esophagus were normal. Endoscopy reports from 1974 to 1982 identified 195 patients with x-ray-negative dysphagia. In no patient was esophageal carcinoma found endoscopically. When patients with hiatal hernia (22) or endoscopic Grade I or II esophagitis (52) were excluded, only eight patients were found to have an endoscopic abnormally not demonstrated previously by x-ray. In addition, 56 cases of esophageal carcinoma seen at our institution over the same period all showed abnormal barium esophagrams at the time of presentation. We conclude that endoscopy to exclude esophageal carcinoma in patients with dysphagia is not as necessary as claimed, at least when adequste barium studies of the esophagus are normal.