From January 1987 till February 1992, a total of 203 consecutive patients with gastric carcinoma were evaluated with endosonography before operation. Endosonographic findings were categorized according to the TNM classification and compared with the histology of the resected specimen (n = 165). The overall accuracy rate of EUS in the assessment of the depth of tumor infiltration was 78%. The sensitivity and specificity of EUS in the detection of regional involved nodes were 82% and 84% respectively. Microscopic tumor invasion and indistinguishable inflammatory changes were the most frequent causes of misinterpretation by EUS. Tumor stenosis was a clear limitation for endosonography in 14% of the cases.