A 80-year-old Caucasian male patient was referred to Yaroslavl Regional Cancer Hospital for follow up upper gastrointestinal (GI) endoscopy after endoscopic submucosal dissection (ESD) for early gastric cancer. In 2012 and 2015 patient underwent curative ESD for early neoplastic lesion of gastric body. Two postESD scars on the greater curvature of gastric body without any signs of cancer recurrence were detected during white light imaging upper GI endoscopy (Olympus EVIS X1, GIF H290EC). Advanced atrophic changes in gastric body and gastric antrum were confirmed at the background gastric mucosa, Helicobacter pylori infection was not detected, no suspicious lesion was identified. Narrow-band imaging (NBI) with magnification and NBI endocytoscopy (520× magnification) was performed for all local mucosal changes. A 2-mm flat area with microvascular irregularity and irregular cellular architecture and marginal crypt epithelium border was detected on ultra-magnifying NBI observation. Target forceps biopsy was taken for histological assessment of the lesion. Histology showed well-differentiated adenocarcinoma.