Diagnostic endoscopy for gastric cancer is underused, leading to late-stage diagnoses and worse survival rates.

• 73% of stage I gastric cancer patients are symptomatic, yet many are diagnosed late.
• Median overall survival varies drastically: 47 months for stage II versus 11 months for stage IV.

Surgeons should advocate for standardized endoscopy protocols to improve early detection and outcomes in symptomatic patients.

• Non-endoscopic diagnoses predict poorer survival, highlighting the need for timely endoscopic evaluation.