The detection and diagnosis of early gastric carcinoma (EGC) will facilitate curative endoscopic resection and improve prognosis. However, diagnosis can be challenging due to the subtle mucosal changes of EGC amid a background of gastritis. To improve detection, the mucosal surface needs to be optimally prepared with use of anti-mucolytics and anti-foaming agents. A meticulous systematic examination using high-definition white light endoscopy is crucial. Indigo carmine chromoendoscopy may help to accentuate mucosal surface irregularities. Upon detection of focal mucosal surface lesions, the nature and extent of the lesion can be further characterized by magnifying narrow band imaging using the VS (vessel and surface) classification system. The VS classification system is based on evaluation of the microvascular (MV) and microsurface (MS) patterns. According to the VS classification system, the characteristic endoscopic findings of EGC include the presence of a clear demarcation line between cancerous and non-cancerous mucosae and the presence of an irregular MV pattern and/or irregular MS pattern inside the demarcation line. The demarcation line is recognizable by the abrupt change in the MV or MS pattern between the lesion and non-lesion areas.