Background: The association of multiple submucosal cysts (MSC) of the stomach with gastric carcinoma has attracted clinical and pathological attention. The aim of the present study was to evaluate the diagnostic ability of endoscopic ultrasonography (EUS) for MSC and to investigate the relationship between MSC and gastric carcinoma. Methods: Six hundred and one patients with variable gastric diseases were examined by EUS. We used two ultrasound endoscopes (GF‐UM2 or GF‐UM3; Olympus, Tokyo, Japan) with either a 7.5 or 12 MHz probe and examined MSC using the water repletion method. Stomachs resected for gastric carcinoma were examined histologically. Results: Endoscopic ultrasonography was able to identify submucosal cysts as echo‐free round masses in the submucosal layer when the cysts were larger than 2 mm in diameter. Of 601 patients with variable gastric diseases, 16 (2.7%) were diagnosed with MSC. Twelve of these cases were accompanied with gastric carcinoma and MSC was histologically confirmed in 11 cases after surgical resection. The frequency of MSC detected by EUS was 4.7% (10/215) of early gastric carcinomas, 1.1% (2/185) of advanced gastric carcinomas and 2.1% (4/195) of other gastric diseases without gastric carcinoma. Six cases were a postoperative recurrence of gastric carcinoma. Only 25% (4/16) of MSC gave rise to endoscopic findings of submucosal tumor(s). Most MSC were distributed in the gastric body and the cysts were located beneath or adjacent to the carcinoma in approximately half the MSC cases accompanied by gastric carcinoma. Conclusions: Endoscopic ultrasonography provides information in the clinical diagnosis of MSC with regard to the existence and distribution of the cysts and the locational relationship between MSC and gastric carcinoma.

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