Gastric ulcers are common, but the prevalence rate of malignancy in endoscopically diagnosed gastric ulcers varies considerably. It is unclear whether endoscopic follow-up is warranted in all patients with gastric ulcers, as the yield of the follow-up endoscopy is very low, especially in the setting when histology shows benign features. We performed a quality improvement project to determine the diagnostic accuracy of combined endoscopic and histologic features in differentiating benign from malignant gastric ulcers vs endoscopic features only and to avoid over-use of endoscopic evaluation of ulcer healing for benign cases.