Gastric cancer (GC) remains an important cancer worldwide and is responsible for over 1,000,000 new cases in 2018, making it the fifth most frequently diagnosed cancer and the third leading cause of cancer death (1). The South American region ranks third in mortality (12 per 100,000 in men and 5.7 per 100,000 in women), only surpassed by Central and Eastern Europe (16.8 and 7.1, respectively) and Eastern Asia (14.0 and 9.8, respectively). Although esophagogastroduodenoscopy (EGD) can detect early stage lesions, in practice, finding an early GC is challenging, even for experts. In fact, studies have reported that 14%-26% of GCcan be missed at an endoscopy performed up to 3 years before (2). Because failure to detect subtle early lesions at endoscopy may contribute to this poor prognosis, efforts should be made to improve quality standards, with the aim of increasing chances for early diagnosis. In this piece we focus on limitations of EGD currently being performed and highlight promising and available strategies to improve detection, including new biomarkers, cleaning the gastric mucosa before the examination, a complete systematic endoscopy method, and a novel image-enhanced technology. CURRENT LIMITATIONS Limitations of upper endoscopy In certain aspects, the way standard EGD is currently being performed impedes rather than promotes early diagnosis and has several limitations to facilitate detection of the disease in an early stage. The manner in which EGD is presently being performed is based primarily on how professors and instructors have been teaching trainees for generations in accordance with their own individual perceptions and experience, resulting in EGD being very much a nonstandardized procedure. On the other hand, although the most commonly performed procedure in the gastrointestinal (GI) arena, endoscopists do not follow a particular order, do not use proper nomenclature to describe areas within the stomach, and tend to record only abnormal mucosal findings (3). Although there is an increasing demand for proper documentation of endoscopic procedures and a rapidly expanding availability of digital image storage, there is still no consensus on a comprehensive definition of what is a complete upper GI examination (4). From a Latin American perspective, the situation is even more disheartening because EGD is now being performed in many countries by physicians from several different specialties including gastroenterologists, GI surgeons, surgeons, and internists, making procedural standardization and quality indicators high-priority issues. © 2019 by The American College of Gastroenterology. Unauthorized reproduction of this article is prohibited.