Gastric cancer (GC) is a multifactorial disease, where both environmental and genetic features can have an impact on its occurrence and development. GC represents one of the leading causes of cancer-related deaths worldwide. GC is most frequent in males and is believed to arise from a series of premalignant lesions. The detection of GC at an early stage is crucial because early GC, which is an invasive stomach cancer confined to the mucosal or submucosal lining, may be curable with a reported 5-year survival rate of more than 90%. Advanced GC usually has a poor prognosis despite current treatment standards. The diagnostic efficacy of conventional endoscopy (with light endoscopy) is currently limited. Confocal laser endomicroscopy is a novel imaging technique that allows real-time in vivo histological examination of mucosal surfaces during endoscopy. Confocal laser endomicroscopy may be of great importance in the surveillance of precancerous gastric lesions and in the diagnosis of GC. In this editorial we commented on the article about this topic published by Lou et al in the recent issue of the World Journal of Clinical Cases .