Background: An initial experience using a digital video processor to enhance contrast in endoscopic images in real-time is described. Methods: Endoscopic images were examined with a system using locally adaptive processing to balance variations in illumination and sharpen fine features in real-time. For comparison, indigo carmine dye, a popular exogenous contrast agent, was applied to one patient. Results: In general, contrast-enhanced images appeared to contain more mucosal detail, with reduced glare and features in shadowed areas revealed. When used in conjunction with indigo carmine, the enlarged crypt openings in an aberrant crypt focus were visible, the first such detection in vivo without the use of magnifying endoscopy. Conclusions: Real-time video contrast enhancement during endoscopic procedures appears to provide excellent mucosal detail and improve contrast in a clinically useful manner.