Gastric ulcer: is endoscopy always necessary?

Crucial to the management of gastric ulceration is the accurate distinction between benign and malignant lesions. Controversy continues over how this should be achieved, the conclusion from a recent retrospective study' being that all gastric ulcers should be assessed endoscopically and tissue obtained for histological diagnosis by means of multiple biopsy and brush cytology. Good-quality double-contrast radiology of the stomach appears to permit accurate prediction of whether a gastric ulcer is benign or malignant provided that the "guideline" pattern around the ulcer crater is adequately shown.2 3 If this is so endoscopy could be reserved for doubtful cases rather than being a routine procedure.