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AIM: To identify important features of the EGD report for preoperative management of gastric cancer and to develop and validate a tool for the same. METHODS: There were 3 parts to the study. Part 1: We conducted a systematic literature review of Medline, Embase and the Cochrane Databases using the search terms “gastric”, “stomach” & “cancer”, “carcinoma”, “neoplasm” or “tumour”. 2 independent evaluators reviewed the abstracts; only those that addressed: “What are the important features of an EGD for the preoperative management of gastric cancer?” were retained. Part 2: A convenience sample comprising 5 gastroenterologists (GIs) and 5 general surgeons (GSxs) from 2 academic and 2 community hospitals was identified. Semi-structured interviews focused on important elements of an EGD report pertaining to gastric cancer and graded these on a 4 point Likert scale. Part 3: Two abstractors separately examined 224 EGD reports at diagnosis from all patients diagnosed with gastric adenocarcinoma (2005-2008) at a community hospital, an academic hospital and a regional Cancer Centre for report elements based on Part 2 results. Kappa statistic was used to compare interobserver reliability for each report element, overall report quality and adequacy for surgical planning. RESULTS: Part 1: The literature review yielded 7117 abstracts, none of which addressed quality of EGD in preoperative planning for gastric cancer. Part 2: Study sample consisted of 80% males who perform a median of 275 (80-1000) EGDs/year. All respondents agreed that size and distance of gastric neoplasm from GEJ should be included in the EGD report. Additionally, 90% felt that appearance of mass, video and photos were important. Tattooing of a neoplasm was important if it was small (30%) or to be treated laparoscopically (40%). All GSxs indicated they would repeat EGD themselves to confirm location of the tumour for surgical planning, regardless of quality and content of the EGD report. Part 3: Interobserver agreement was excellent (K>0.7) in abstraction of tumour distance from GEJ, Siewart Type, tattooing and description of tumour appearance. These were documented in 31 vs 33% (K 0.8 [0.7-0.9]), 0% (K 1) and 3% (K 1) of reports respectively. Ulceration was used as a descriptor for tumour appearance in 56 vs 57% (K 0.8 [0.7-0.9]). Agreement was fair in report adequacy for surgical planning (K 0.3 [0.2-0.4]) with 30 vs 33% of reports being inadequate. CONCLUSIONS: There is a paucity of research on the quality of EGD reporting in preoperative management of gastric cancer. Experienced practitioners felt that the most important aspects of an EGD report for preoperative management of gastric cancer were location, size and description of neoplasm. Evaluation of EGD reports by these criteria reveals need for standardization of EGD reporting to improve gastric cancer care.