Because early gastric cancer is associated with a much better prognosis than advanced disease, its diagnosis is important. Over a 12 year period (1976-87), a progressive increase in the incidence of early gastric cancer was observed. Twenty four of the 718 (3.3%) consecutive gastric resections for gastric cancer in this period were in patients with early gastric cancer. Six of the 24 were diagnosed in the first six year period (1976-81) and 18 in the second six year period (1982-87) (p less than 0.01). This increase was observed during the prospective phase of the study, when all patients diagnosed on initial biopsy specimen as showing type III intestinal metaplasia underwent follow up endoscopy and biopsy at six to 12 month intervals. Eleven of the 18 with early gastric cancer detected in this period were diagnosed as a direct result of this follow up. We conclude that early gastric cancer can be diagnosed with increasing frequency if patients with type III intestinal metaplasia are closely followed endoscopically.
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