Given the doubling time for EGC the cancers must have been present at the earlier investigation, but were overlooked. This all suggests that improved knowledge and awareness of the various forms of EGC is required, rather than a reassessment of its very existence. The outcomes of endoscopically screened and non-screened groups were compared. However this study does not provide such evidence for two reasons. First, the majority of the non-screened population were those who did not accept an offer of endoscopic survey for remnant stomach cancer, while the screened population were those who accepted it.
Enormous bias exists with such a selection method.
Two were treated for EGC by a local resection of the stump without lymph node dissection and eventually developed local recurrence. In spite of regular invitation, another five patients did not undergo endoscopy at least 6 years before they had incurable disease. Another patient whose previous biopsy was diagnosed as dysplasia did not undergo endoscopy for 5 years. For one patient endoscopic biopsy was not performed because regular use of warfarin, resulting in the delayed diagnosis of signet cell carcinoma. Two other patients developed symptoms and eventually were diagnosed with gastric cancer in the 3-year interval between examinations.