Serum biomarkers for the detection of gastric cancer are needed even now in order to find a larger number of candidates for suspected gastric cancer. We evaluated the usefulness of a novel serum marker, REG4, as compared to that of CA19-9, CEA, and pepsinogen.,Pre-therapeutic sera were collected from 74 patients with gastric cancer and 106 healthy controls without any cancers. REG4, CEA, CA19-9, and pepsinogen serum levels were measured in each group. The cut-off value of REG4 was defined, and then the usefulness of REG4 was evaluated with a validation study that included sera collected from 37 patients with gastric cancer and 44 healthy controls without any cancers.,REG4 levels were significantly higher in early gastric cancer patients (median 8.42 ng/ml) than in controls (median 5.01 ng/ml) (p < 0.001), and in advanced gastric cancer patients (median 13.12 ng/ml) than in early gastric cancer patients (p < 0.02). A cut-off value of 6.67 ng/ml was defined using the receiver operating characteristics curve. The sensitivity for gastric cancer was 73.0%, the specificity was 70.8%, and the accuracy was 71.8%. Diagnostic accuracy of REG4 was superior to that of the other tests. In the validation study, the sensitivity for gastric cancer was 94.5%, the specificity was 31.8%, and the accuracy was 60.5%.,Serum REG4 level can be a useful indicator to distinguish between patients with gastric cancer and healthy subjects. This has the potential to be used as a screening serum marker for gastric cancers, including cancers in the early stages.