Gastric cancer is one of the most common malignancies worldwide in terms of incidence and mortality.Nearly one million new cases of gastric cancer were diagnosed in 2008, representing 7.8% of all new cancer cases in that year.Most of those diagnosed patients died of this malignancy [1].Late diagnosis, lack of effective treatment with tumor invasion and distant metastasis, as well as the poor understanding of the molecular mechanisms involved in the development of gastric cancer are among the major factors responsible for poor prognosis and high mortality rate.Advanced gastric cancer is not only associated with poor prognosis, but is also an important source of heavy financial burden and poor quality of life.The witnessed improvement in long-term survival rate of patients with gastric cancer over the past few decades is mainly attributable to improved early diagnosis and radical management [2].As a comparison, the 5-year survival rate for advanced gastric cancer was reported to be 29% whereas that for early gastric cancer (EGC) was 91.8% [3].Apparently, early diagnosis and treatment are the key components of effective management of patients with gastric cancer.However, the diagnosis and treatment of EGC remain a great challenge even in the hands of the experienced endoscopic experts.Pathologically, EGC refers to the carcinoma with invasion depth limited to mucosa or submucosa.EGC can only be reliably diagnosed endoscopic ally [4].Over the recent years, many endoscopic diagnostic approaches have been developed, such as endoscopic ultrasound (EUS), chromoscopy, the narrowband imaging zoom endoscope (NBI), confoeal laser endomicroseopy, magnifying chromoendoscopy, autoflourescent endoscopy and infrared endoscopy.These newly developed endoscopic procedures have remarkably improved the diagnostic accuracy and enhanced the resection rate of EGC.Endoscopic submucosl dissection (ESD) has great advantages over conventional surgical resection in the management of EGC.As such, this procedure has been adopted as the standard method to treat the patients with EGC [5-7].Measurement of serum biochemical parameters such as pepsinogen and Helicobacter Pylori IgG (HP-IgG) coupled with intelligent dyeing endoscopy (i-scan) has also been shown to greatly improve the detection rates of EGC, and the patients can have the chance to be radically cured at early stage [8].In this article, we will systematically review the recent development in the endoscopic diagnosis and treatment of EGC.The article would greatly interest the gastroenterologists and surgical endoscopists.