Limited surgery for an early gastric carcinoma is advocated, since certain carcinomas have no nodal involvement. However, the endoscopic accuracy of distinguishing each cancer-depth has not been detailed from the standpoint of limited surgery. We retrospectively reviewed a total of 2,628 patients to assess the diagnostic accuracy of their endoscopic infiltration-depth with the nature of the tumors. Endoscopic distinction of early from advanced carcinomas was satisfactory with a reliability of 86.5%, sensitivity of 87.1%, and specificity of 85.9%. In the 1,354 early gastric carcinomas the microscopic infiltration-depth was significantly related to macroscopic appearance, histologic differentiation and tumor size. Accompanying ulcer or scar significantly suggested that the carcinoma had spread vertically and horizontally. Macroscopically elevated and differentiated carcinomas without ulcer are usually limited to the mucosa, and undifferentiated and/or ulcer-positive carcinomas are more invasive than predicted by most present clinical standards. Endoscopically differential diagnosis of the infiltration-depth of gastric carcinomas is reliable, and the indication for limited surgery can be endoscopically determined in many individual patients.

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