PURPOSE: Although the role of gastric epithelial dysplasia (GED) as a biological and morphological precursor of gastric cancer has been widely investigated, controversy remains with regard to the pathological grading systems and therapeutic strategies. The purpose of this retrospective study was to analysis the clinicopathological characteristics and treatment results of GED and to establish a rational therapeutic strategy for its use. METHODS: Between 1999 and 2002, a review and analysis of 72 patients initially diagnosed as GED was undertaken. RESULTS: 38.4% of low grade dysplasia (LGD) progress to high grade dysplasia (HGD), and 25% of the progressed HGD are diagnosed as an adenocarcinoma by definitive treatment. 40% of HGD cases progress to adenocarcinoma. In 10 of 54 cases a repeated endoscopic examination revealed an adenocarcinoma. 2 of 10 cases were diagnosed as LGD on the first endoscopic examination. However, these cases had a definitive operation after being diagnosed as HGD on a follow up endoscopic biopsy. 8 of 10 cases were diagnosed as HGD on the first endoscopic examination. There were 10 adenocarcinoma cases were no lymph node metastasis. 9 cases had invasion of the mucosal layer and 1 of the muscularis layer. CONCLUSION: Cases diagnosed as LGD require persistent and repeated endoscopic examinations. Cases diagnosed as HGD require frequent and multifocal endoscopic biopsies to detect coexisting or transient carcinomas. The therapeutic strategy for HGD might be EMR, endoscopic assisted operation or a gastrectomy, depending on the patient's general condition and the size and location of the dysplastic lesion.