The prognosis for gastric cancer depends on its stage; so, detection in the early stage of disease is important, when complete and curative removal is possible. Accurate diagnosis can be facilitated by a sound understanding of the basic findings of white light endoscopy of early gastric cancer, and diagnosis can be refined further by the combined use of other imaging modalities such as image-enhanced endoscopy including chromoendoscopy and endoscopic ultrasonography. Minimally invasive endoscopic treatment has come to be the preferred therapeutic approach for early gastric cancer. In addition to conventional endoscopic mucosal resection, a new technique known as endoscopic submucosal dissection (ESD) has spread rapidly worldwide. Indeed, strategies for ESD have been established, devices developed, its indications expanded, and its safety and long-term results extensively reported. Some unique combination therapies involving endoscopy and surgical treatment have also been reported. It is anticipated that the number of patients undergoing endoscopic therapy will continue to increase, and the ongoing developments in endoscopic treatment are expected not only to improve gastric cancer prognosis but also to maintain good quality of life after treatment. 1. Introduction Despite both the incidence and mortality rates of gastric cancer showing decreasing trends, gastric cancer remains one of the most common causes of death by cancer worldwide [1, 2]. There are significant regional differences in gastric cancer onset, with East Asian countries, including Japan and Korea, known to have a particularly high incidence rate compared to the Western countries. In Japan, following the introduction of a mass screening program that utilizes double-contrast barium radiography for early the detection of gastric cancer and alongside developments in endoscopic equipment and improved diagnostic capability, gastric cancer is now being detected more often in the asymptomatic stages [3]. As a result, approximately 50% of the cases of gastric cancer currently treated in Japan are early stage disease [4]. In contrast, in Western countries, gastric cancer is often detected at an advanced stage and prognosis remains poor. Prognosis depends on the stage at which it is detected, and complete excision of the cancer is the only curative option. The excellent postoperative results for early gastric cancer, with a 5-year survival rate of over 90% in both Western countries and Japan, indicate just how important it is to detect the cancer at the earliest possible stage [5, 6]. Moreover, with
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