Synchronous early gastric cancer (EGC) has a prevalence of approximately 9%. The barium study findings of 73 patients with 163 synchronous EGC tumors were retrospectively reviewed, and the size, location, and morphologic type of each lesion considered malignant were analyzed and correlated with the endoscopic and final pathologic findings. Barium studies and endoscopy each correctly demonstrated 116 of the 163 synchronous EGC lesions. Those lesions not demonstrated by either technique were small, shallow, or flat and confined to the mucosa. Our results indicate that a careful preoperative evaluation with radiography and endoscopy currently can depict about 70% of these lesions.