Difficulties that occur in the diagnosis of early gastric carcinoma (EGC) were studied on a material of 1617 prophylactic endoscopic examinations of persons who did not make any complaints of the alimentary organs and 2158 primary gastroscopies performed in accordance with the patients' complaints, results of the dispensary follow-up of 811 patients who made up a risk group, and an analysis of case reports of 183 patients in whom EGC was confirmed by surgery. The authors emphasize a high percentage of errors determined by the lack of the pathognomonic symptomatology, difficulties of interpreting the endoscopic appearance and histologic confirmation of carcinoma. To improve early diagnosis of gastric carcinoma (GC), it is recommended that every endoscopic investigation be performed with oncological apprehension, paying attention even to the minimum focal changes in the gastric mucosa and making spot biopsy of those changes. It is also advisable that a more strict approach should be exercised to the formation of risk groups, restricting them to the patients at greater risk for GC or with unrecognized GC (first revealed and poorly healing ulcers, polyps measuring over 2 cm in diameter, grade III dysplasia discovered in gastric biopsy specimens). Such patients should be placed under dispensary observation including endoscopy which is to be made in the first stage after 1, 3 and 6 months.