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countries with high gastric cancer incidence and mortality, such as East Asian countries. Endoscopy plays an increasingly important role in screening and diagnosis of gastric cancer. For instance, in Japan, endoscopy has been recently accepted as a primary tool in population-based gastric cancer screening [1]. Endoscopy is also a vehicle for modern gastric cancer treatments, such as endoscopic submucosal dissection (ESD) [2– 4]. Although advanced gastric cancer still has a poor prognosis, patients with early-stage disease treated with ESD are likely to have favorable outcomes [3–5]. For that reason, early detection of gastric cancer is important and endoscopy is a critical tool for its early detection, diagnosis, and treatment. Endoscopy is considered to be the most powerful tool for detecting gastric cancer [6]; however, it does not always find existing cancers, and its miss rate has been examined in several studies. In 2014, a meta-analysis by Menon et al., published in Endoscopy International Open, examined how commonly upper gastrointestinal (GI) cancer is missed at endoscopy [7]. The authors defined missed cancers as cancers that had not been diagnosed by endoscopies performed within 3 years before diagnosis, based on the hypothesis that mucosal cancer has a 2–3year doubling time [8]. The study concluded that 11.3% of upper GI cancers were missed at endoscopy performed within 3 years before the diagnosis, and showed that 0.25% of all the endoscopic procedures missed existing upper GI cancers. Although these data are important and informative, interpreting the results can be difficult because the examined upper GI cancers included both gastric cancers and esophageal cancers, and also cancers at various stages. Considering the heterogeneity of these lesions, the limitations of this study (particularly the definition of missed cancer based on a specific interval between diagnosis and preceding endoscopy) cannot be ignored; further data on missed cancers from studies performed in different study methods are therefore needed. In this regard, the paper by Shimodate et al. from a Japanese institution published in Endoscopy International Open 2017, provides us with a wider perspective [9]. The authors examined the miss rate of gastric superficial neoplasia (GSN) by reviewing GSN patients’ earlier endoscopic records, rather than defining missed cancers by the interval between diagnosis and preceding endoscopy. Although the study has several limitations (e. g. retrospective design, possible selection bias, and lack of full information on preceding endoscopies), five endoscopists in this study actually reviewed the images of the preceding endoscopies and judged the existence of the missed lesions. The study concluded that the miss rate for GSN was 75.2%. The rate seems surprisingly high, but it is necessary to understand the meaning of the value appropriately. This value means not the miss rate of GSN among all endoscopic procedures but the proportion of GSNs overlooked at the preceding endoscopies among all GSNs. In addition, because missed cancers were defined quite differently in this study than in the Menon meta-analysis, their miss rates are difficult to compare [7]. However, even after considering the new definition for miss rate in the Shimodate study and the study’s possible selection bias, the High miss rate for gastric superficial cancers at endoscopy: what is necessary for gastric cancer screening and surveillance using endoscopy?