The paper by Ono and colleagues1 in this issue of Gut documents the remarkable results achieved at the Tokyo National Cancer Centre Hospital (NCCH) with endoscopic management of early gastric cancer (EGC) (see page225). EGCs constitute a much higher proportion of the total number of gastric cancers in Japan than is the case in the West. There are a number of reasons for this: firstly, many asymptomatic subjects in Japan are screened for gastric cancer (usually by barium radiology, followed, if necessary, by endoscopy); secondly, Japanese diagnostic gastroscopy is a much more careful procedure than the “smash and grab” style of endoscopy which is typical in this country: the stomach is inflated to a greater degree, indigo carmine dye spraying is used to examine any suspicious area, and simethicone (to eliminate bubbles and froth) and hyoscine (to paralyse the stomach) are used routinely. There is some evidence that early lesions are missed in the UK: a recent audit in one centre showed that 11 of 81 patients presenting with advanced gastric cancer had undergone endoscopy within the previous two years.2

Is EGC in Japan the same disease as EGC in the West? A recent analysis of published data from Japan and the rest of the world …