This issue of Gut presents a paper from Osaka, Japan1 reporting the long term outcome of 71 patients diagnosed with early gastric cancer (EGC) before 1988, but who were not immediately operated on because of age, infirmity, or refusal (see page 618). Thirty six EGCs (51%) progressed to advanced cancer. After exclusion for incomplete follow up, a Kaplan-Meier plot showed the likelihood of progression over five years to be 63%. Thirty eight of the 71 patients were never operated on. Of these, 23 (61%) died from gastric cancer. The Kaplan-Meier plot predicted a five year survival in this group ranging from 63 to 68% depending on the allocation of patients in whom the outcome was unknown.

This is an important paper because few studies have followed the natural history of early gastric cancer and it will be difficult to repeat in the future because of the development of endoscopic mucosal resection (EMR) …