Gastroscopy is the diagnostic measure of choice in early recognition of gastric carcinoma, offering an accuracy rate of 96-99. However, this goal can only be achieved when biopsies are taken with forceps and snare from all circumscribed lesions which may hide a carcinoma. The common association with hyperplasiogenic polyps (15/86), adenoma and borderline lesion (7/86) and synchronous gastric carcinoma (8/86) request a subtle preoperative diagnosis if one does not perform gastrectomy in principle. Endoscopic resection (5/86) or local excision (6/86) should be debated in carcinomas located close to the cardia, and in high-risk patients. 5-year-survival rates of the "Erlangen early gastric cancer registry", are in accordance with the excellent results reported in the Japanese literature.