Global Variability in the Implementation of Gastric Cancer Prevention Guidelines: A Multinational Survey

Background and study aim Gastric cancer (GC) remains a major cause of cancer-related mortality worldwide. Although international guidelines recommend strategies for screening, diagnosis, and surveillance of gastric premalignant conditions, their implementation in clinical practice remains uncertain. This study aimed to evaluate global endoscopic practices and adherence to GC prevention guidelines. Patients and methods We conducted a multinational web-based cross-sectional survey between August and September 2025 among endoscopists from 32 countries. A 28-item questionnaire assessed demographics, screening strategies, endoscopic technical practices, pathology infrastructure, H. pylori management, and surveillance policies. The primary outcome was characterization of current practices in GC screening and management of premalignant gastric conditions. Secondary outcomes included variability according to country and experience, and adherence to guidelines. Descriptive statistics, chi-square testing, and the Index of Qualitative Variation assessed heterogeneity. A composite guideline adherence score based on six indicators was calculated, and hierarchical clustering identified country-level adherence patterns. Results A total of 863 physicians participated, most of whom were certified gastroenterologists. Routine H. pylori testing during endoscopy was reported by 73.7% ( n = 635) of respondents, while access to high-definition endoscopy with virtual chromoendoscopy was available to 58.7% ( n = 507). Although photo-documentation was widely available (90.4%, n = 780), only 40.6% ( n = 350) consistently documented recommended anatomical sites and 20.4% ( n = 176) used structured reporting systems. Guideline-based surveillance was reported by 85.7% ( n = 737) of respondents. Cluster analysis identified three country-level adherence groups with mean scores of approximately 0.83, 0.60, and 0.41. Conclusions Implementation of GC prevention guidelines varies worldwide. Infrastructure, training, and healthcare organization appear to be key determinants of adherence rather than national GC incidence.