Over an 8-yr period at the Houston Veterans Hospital, 731 endoscopic gastric salvage cytologies were performed in 671 patients, with surgical biopsy also done in 660. Seventy-six patients subsequently had tissue biopsy-proven or resection-proven malignancies. Salvage cytology had a sensitivity of 91% and a specificity of 100% for the detection of primary adenocarcinoma. Biopsy alone had a sensitivity of 92%; endoscopic gastric salvage cytology and surgical biopsy combined had a sensitivity of 100% in both primary and metastatic neoplasms. This study shows that the combination of endoscopic biopsy and salvage cytology increases the diagnostic accuracy for gastric carcinoma. Gastric salvage cytology requires minimal disruption of the routine endoscopic procedure and is therefore an easier and more rapid cytologic technique than gastric brushing cytology.