Optimal Surveillance of Metachronous Gastric Lesion after Endoscopic Resection of Early Gastric Cancer

Sep 21, 2026

Optimal surveillance after curative endoscopic resection (ER) of early gastric cancer is critical because a substantial area of gastric mucosa remains and may develop atrophy or intestinal metaplasia, leaving a persistent risk of metachronous gastric cancers (MGCs). This review synthesizes published evidence to determine the optimal surveillance interval for early identification of MGCs. Median MGC occurrence is within 3 years, and multiple reports suggest biannual endoscopy during the first 3 years, while also highlighting how individual patient characteristics can modify risk.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Introduction

Rationale for Regular Surveillance After Curative ER

Evidence on Timing and Surveillance Interval

Role of Patient Characteristics in Risk Stratification

Gut and Liver [https://doi.org/10.5009/gnl240027](https://doi.org/10.5009/gnl240027)[ ](https://doi.org/10.5009/gnl240027)[pISSN 1976-2283 eISSN 2005-1212](pISSN 1976-2283 eISSN 2005-1212) Review Article | Optimal Surveillance of Metachronous Gastric Lesion after Endoscopic Resection of Early Gastric Cancer
Dong Chan Joo, Gwang Ha Kim
Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea | | | | --- | --- | --- | | Article Info | Endoscopic resection (ER)–a minimal invasive procedure, compared to surgical gastrectomy, | | | Received January 15, 2024 | with the advantage of preserving the entire stomach and maintaining the patient’s quality of life–is | | | Revised February 29, 2024 | a widely used curative treatment for early gastric cancers (EGCs) . Despite its advantages, such | | | Accepted March 14, 2024 | as the preservation of the whole stomach, a large area of the gastric mucosa with histologic | | | Published online August 8, 2024 | changes such as atrophy and intestinal metaplasia remains after ER, and so does the risk of metachronous gastric cancers (MGCs) . Therefore, regular surveillance endoscopy after curative | | | Corresponding Author | ER of EGCs is important so that MGCs are detected early and so minimally invasive ER remains | | | Gwang Ha Kim | a treatment option. To date, the optimal interval for surveillance endoscopy after curative ER of | | | ORCID [https://orcid.org/0000-0001-9721-5734](https://orcid.org/0000-0001-9721-5734) | EGCs has not been established. Therefore, this review summarizes the results of the published | | | [E-mail](E-mail doc0224@pusan.ac.kr)[ doc0224@pusan.ac.kr](E-mail doc0224@pusan.ac.kr) | studies on this topic with the aim of establishing the optimal surveillance interval for early identification of MGCs. Based on my review, the median timing of MGC occurrence is within 3 years, and reports suggest biannual endoscopy during the first 3 years; however, the evidence suggests that individual patient characteristics may influence the risk of MGCs. Therefore, stratified endoscopic strategies for surveillance based on patient characteristics, such as age, family history of gastric cancer, synchronous gastric lesions, and corpus intestinal metaplasia, should be applied.
(Gut Liver 2024;18:781-788)
Key Words: Gastric cancer; Endoscopic resection; Metachronous neoplasms; Surveillance | | |
INTRODUCTION | | area of gastric mucosa, especially with atrophy and intestinal metaplasia, remains after ER. Thus, the occurrence of | | Gastric cancer is the fifth most common malignant | | metachronous gastric cancers (MGCs) remains an impor- | | neoplasm and the fourth leading cause of cancer death | | tant concern after curative ER for EGCs. However, consid- | | globally.1 The diagnosis of early gastric cancers (EGCs) has | | ering that EGCs develop most commonly in the middle | | been increasing because of the widespread use of endosco- | | to lower third of the stomach, when distal gastrectomy is | | py, especially during health check-ups, and advances in the | | performed for EGCs, this high-risk area for gastric cancer | | development of endoscopy equipment, such as high-defi- | | is entirely resected, leaving only the lower-risk portion of | | nition endoscopy and image-enhanced endoscopy.2 Endo- | | the stomach intact. Accordingly, ER for EGCs only resolves | | scopic resection (ER), particularly endoscopic submucosal | | a particular lesion and does not influence the overall can- | | dissection (ESD), is a widely used curative treatment for | | cer risk in the whole stomach; therefore, life-long regular | | EGCs. ESD has histopathologically high en bloc, complete, | | surveillance endoscopy is needed in these patients who | | and curative resection rates for EGCs regardless of their | | have undergone ER as they remain at a high risk of ga

FAQs

Why is regular surveillance endoscopy necessary after curative ER for early gastric cancer?

Because ER removes only a specific lesion; the remaining gastric mucosa can still develop atrophy and intestinal metaplasia, so patients remain at high risk for metachronous gastric cancers. Regular surveillance helps detect MGCs early enough for curative treatment.

What does the review suggest about the timing of MGC occurrence after ER?

The median timing of MGC occurrence is within 3 years after curative ER. Reported evidence suggests more intensive follow-up during this early period.

Is surveillance endoscopy the same for all patients?

No. The review emphasizes that individual patient characteristics may influence MGC risk, so stratified surveillance strategies based on factors such as age, family history, synchronous gastric lesions, and corpus intestinal metaplasia should be considered.

Sep 21, 2026

Upload by Theodore