Objective To evaluate endoscopic uhrasonography (EUS) for TN restaging and predic- ting response to advanced gastric cancer after neoadjuvant chemotherapy. Methods A total of 22 patients, 15 males and 7 females, mean age 64 (36-80 years), with advanced gastric cancer were recruited to the study from June 2007 to December 2009 with written informed consents. All patients underwent 3 cycles of neoadjuvant chemotherapy ( Folfox 6), and subsequent surgery ( R0 resection) in 3-4 weeks after chemotherapy. EUS was performed 1-2 weeks before and 1-2 weeks after chemotherapy. EUS TN staging was compared with pathological findings. The correlation of peri-chemotherapy EUS TN staging with postoperative pathological response was evaluated. Results After chemotherapy, the overall accuracy of EUS T staging was 63.6% (14/22), with overstaging (36. 4%, 8/22) more frequent than understaging (0). The overall ac-curacy of N staging was 54. 5% (12/22) with 4 ( 18.2%, 4/22) overstaging and 6 (27.3%, 6/22) un- derstaging. EUS revealed T and/or N downstaging (concurrence of T and N downstaging was aceounted once) after chemotherapy in 10 patients, with 9 T downstaging (4 from T3 to T2, 5 from T4 to T3) and 4 N downstaging (4 from N1 to NO). TN downstaging was correlated with pathological response, with 7 patients achieving pathological response 2 and 1 patient 3. Conclusion T and N restaging by EUS after neoadjuvant chemotherapy in patients with locally advanced gastric cancer is not accurate enough. However, T and/or N downstaging confirmed by EUS is well correlated with a better degree of pathologieal response to chemotherapy. Key words: Gastric cancer; Endoscopic ultrasonography; Cancer chemotherapy protocols; Staging, Neoplasm