Effectiveness of Gastric Cancer Endoscopic Screening in Intermediate-Risk Countries-A Systematic Review and...

Area of Science:

• Gastroenterology
• Oncology
• Health Economics

Background:

• Gastric cancer is a leading cause of cancer mortality in intermediate-risk countries.
• Endoscopic screening is common in high-risk areas, but its value in intermediate settings is unclear.
• This study systematically reviews the effectiveness and cost-effectiveness of endoscopic screening for gastric cancer in intermediate-risk populations.

Purpose of the Study:

• To evaluate the effectiveness of upper gastrointestinal endoscopic screening for gastric cancer.
• To assess the cost-effectiveness of endoscopic screening in intermediate-risk countries.
• To analyze detection rates of precancerous conditions, gastric cancer (overall and early-stage), and gastric cancer-specific mortality.

Main Methods:

• Systematic review and meta-analysis of studies on upper gastrointestinal endoscopic screening (esophagogastroduodenoscopy - EGD).
• Searches conducted in Medline, Scopus, Embase, and Web of Science up to September 30, 2024.
• Pooled estimates calculated for detection rates and mortality; subgroup analyses performed by screening strategy and region.

Main Results:

• Thirty-two studies (24 effectiveness, 8 cost-effectiveness) included 404,159 individuals.
• Pooled detection rates: 25.5% for precancerous conditions, 3.3% for neoplastic lesions, 91.6% for early-stage cancer among neoplastic cases.
• Direct EGD showed higher detection of precancerous conditions (32.5% vs. 17.0%) and early-stage cancer (95.8% vs. 87.3%) than pre-selection; cost-effectiveness demonstrated, especially when combined with colorectal screening.

Conclusions:

• Endoscopic screening (EGD) has significant potential for early gastric cancer detection in intermediate-risk countries.
• Data on survival and mortality are primarily from Chinese studies, limiting generalizability.
• Implementing endoscopic screening, particularly integrated with colorectal screening or risk stratification, appears feasible and effective.