{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T10:04:02Z","timestamp":1790157842667,"version":"4.1.0"},"reference-count":20,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["DEN Open"],"published-print":{"date-parts":[[2027,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>\n                      We compared synchronous and metachronous gastric tumors detected during index evaluation and surveillance after endoscopic submucosal dissection (ESD), focusing on Kimura\u2010Takemoto O\u20103 atrophy.\n                      <jats:italic>Helicobacter pylori<\/jats:italic>\n                      eradication history and the neutrophil\u2010to\u2010lymphocyte ratio (NLR) were exploratory.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed consecutive patients who underwent ESD. Patients whose first additional lesion was detected simultaneously or within 1 year after index ESD were classified as having synchronous gastric tumors (SGT); those with no synchronous lesion whose first additional lesion was detected later were classified as having metachronous gastric tumors (MGT). Logistic regression estimated associations with SGT rather than MGT presentation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 1064 screened patients, 256 had multiple lesions (SGT,\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0169; MGT,\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a087). SGT patients were older (median, 76\u00a0vs. 72 years;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.005), and O\u20103 atrophy was more frequent (34.3%\u00a0vs. 20.5%;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.045). In exploratory multivariable analysis, age (adjusted odds ratio [aOR], 1.67 per 10 years; 95% confidence interval [CI], 1.12\u20132.51) and O\u20103 atrophy (aOR, 2.17; 95% CI, 1.01\u20134.65) were associated with SGT presentation. Eradication timing was unavailable, and NLR was not independently associated with SGT.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>O\u20103 atrophy was more frequent when the first additional lesion was detected synchronously. SGT and MGT may represent timing\u2010defined phenotypes within a continuous atrophic field rather than biologically distinct entities. Extensive atrophy supports meticulous whole\u2010stomach inspection at index evaluation and sustained surveillance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/deo2.70437","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T09:12:02Z","timestamp":1790154722000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Synchronous and Metachronous Multiple Gastric Epithelial Neoplasms Detected During Index Evaluation and Post\u2010Endoscopic Submucosal Dissection Surveillance: A Descriptive Comparison"],"prefix":"10.1002","volume":"7","author":[{"given":"Tomokazu","family":"Yoshio","sequence":"first","affiliation":[{"name":"Department of Medicine Division of Gastroenterology, Kurume University School of Medicine  Kurume Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuhei","family":"Fukunaga","sequence":"additional","affiliation":[{"name":"Department 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