Fujihara et al. Journal of Medical Case Reports 2012, 6:268 http://www.jmedicalcasereports.com/content/6/1/268 difficult in many cases because of diffuse bleeding. Early consultation with a surgeon is warranted when hemo- stasis is difficult to achieve. Hemostatic forceps may be an effective and safe alternative approach for active GI bleeding of various origins. The incidence of multiple synchronous gastric cancers (MSGC) is thought to be about 4% to 15% in patients with gastric cancer [8,9]. Our patient had seven synchronous gastric cancer lesions. Patients with two or three cancer lesions are frequently seen; however, there are few reports describ- ing patients with four or more multiple gastric cancer lesions. Cases of MSGC with seven or more lesions are very rare [10]. A review of the literature revealed that many patients with MSGC had accessory lesions that were overlooked preoperatively and detected after sur- gery by histological examination [11,12]. Sixteen patients (11%) had synchronous multiple early gastric cancer lesions within one year of the initial EMR. About half of the multiple lesions were located in the same third of the stomach as the primary lesion, and most lesions were similar in macroscopic type to the primary lesions. Most multiple lesions were of the differentiated type. Conclusions In our opinion, EMR might be suitable as a bridging therapy for bleeding tumors after other failed interven- tions, but not as the primary method of treatment. In addition, we report a rare case of multiple synchronous early gastric carcinomas with eight lesions. Consent Written informed consent was obtained from the patient for publication of this manuscript and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Competing interests The authors declare that they have no competing interests. Authors’ contributions SF, HM, NN, MK and HK made substantial contributions to the acquisition and interpretation of data. TM gave final approval of the version to be published. All authors read and approved the final manuscript. Authors’ information All authors are specialized in the diagnosis and treatment of all diseases in both the upper and lower GI tract. Research projects of our team include clinical and basic research for advanced endoscopic therapy, especially endoscopic submucosal dissection and natural orifice transluminal endoscopic surgery. Received: 10 January 2012 Accepted: 22 June 2012 Published: 31 August 2012 References 1. Savides TJ, Jensen DM, Cohen J, Randall GM, Kovacs TO, Pelayo E, Cheng S, Jensen ME, Hsieh HY: Severe upper gastrointestinal tumor bleeding: endoscopic findings, treatment, and outcome. Endoscopy 1996, 28:244–248. Page 4 of 4 2. 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Isozaki H, Okajima K, Hu X, Fujii K, Sako S: Multiple early gastric carcinomas. Cancer 1996, 78:2078–2086. doi:10.1186/1752-1947-6-268 Cite this article as: Fujihara et al.: Endoscopic hemostasis with endoscopic mucosal resection and multiple synchronous early gastric cancers: a case report. Journal of Medical Case Reports 2012 6:268. Submit your next manuscript to BioMed Central and take full advantage of: • Convenient online submission • Thorough peer review • No space constraints or color ﬁgure charges • Immediate publication on acceptance • Inclusion in PubMed, CAS, Scopus and Google Scholar • Research which is freely available for redistribution Submit your manuscript at www.biomedcentral.com/submit