Post-endoscopy gastric cancer in Latin America: a multicentre cohort study from Colombia

Post-endoscopy gastric cancer (PEGC), defined as gastric cancer diagnosed after a negative upper gastrointestinal endoscopy, is considered a key indicator of endoscopic quality. Although international studies estimate that PEGC accounts for 5-11% of gastric cancer cases, evidence from Latin America remains scarce.

We conducted a retrospective multicentre observational study across three tertiary hospitals in Bogotá, Colombia (2024-2025). Adult patients with histologically confirmed gastric neoplasms were included. PEGC was defined as cancer diagnosed between 6 and 36 months after a negative endoscopy. Clinical characteristics, tumour location, and hospital outcomes were compared between PEGC and non-PEGC cases.

Amongst 599 patients, 71 met criteria for PEGC, corresponding to a frequency of 11.9% (95% CI: 9.5-14.7). Helicobacter pylori positivity was 67.1% overall and 70.4% amongst PEGC cases. PEGC was associated with higher rates of palliative management (23.9% vs 2.8%; OR 10.77; 95% CI: 5.09-22.77; p<0.001) and increased in-hospital mortality (16.9% vs 7.0%; OR 2.70; 95% CI: 1.33-5.46; p=0.004).

PEGC was frequent in this Colombian cohort and associated with adverse hospital outcomes, highlighting missed diagnostic opportunities and the need to strengthen endoscopic quality standards in high-burden regions. These findings support the incorporation of PEGC rate as a quality indicator for upper gastrointestinal endoscopy in high-incidence regions.