{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T16:06:21Z","timestamp":1791216381846,"version":"4.1.0"},"reference-count":68,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T00:00:00Z","timestamp":1754092800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T00:00:00Z","timestamp":1754092800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["UEG Journal"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Gastric cancer remains a major cause of cancer\u2010related mortality in intermediate\u2010risk countries. Although endoscopic screening is widely implemented in high\u2010risk regions, its effectiveness and economic viability in intermediate\u2010risk settings remain uncertain. This systematic review and meta\u2010analysis evaluated the effectiveness and cost\u2010effectiveness of endoscopic screening in these countries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic review and meta\u2010analysis was conducted to assess the effectiveness and cost\u2010effectiveness of upper gastrointestinal endoscopic screening by esophagogastroduodenoscopy (EGD) for gastric cancer. Searches were performed in Medline, Scopus, Embase, and Web of Science up to 30 September 2024. Pooled estimates were calculated for the detection of precancerous conditions, gastric cancer (overall and early\u2010stage), and gastric cancer\u2010specific mortality. Subgroup analyses were performed by screening strategy and geographic setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Thirty\u2010two studies met inclusion criteria\u201424 on screening effectiveness and eight on cost\u2010effectiveness. Among 404,159 individuals screened, the pooled detection rate for precancerous conditions was 25.5%, for gastric neoplastic lesions 3.3%, and for early\u2010stage cancer among neoplastic cases 91.6%. Gastric cancer\u2010specific mortality was 26.1%, and 5\u2010year survival reached 75.7%. Subgroup analyses of studies using direct EGD versus pre\u2010selection indicated higher detection of precancerous conditions (32.5% vs. 17.0%,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001) and early\u2010stage cancer (95.8% vs. 87.3%,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001). Comparing Chinese versus other settings, similar detection rates were found for precancerous conditions (25.3% vs. 26.0%) and early\u2010stage detection (91.5% vs. 100%). Economic analyses suggest that endoscopic screening is cost\u2010effective in intermediate\u2010risk settings, particularly when combined with colorectal screening, with incremental cost\u2010effectiveness ratios within accepted willingness\u2010to\u2010pay thresholds.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Endoscopic screening by EGD shows strong potential for early detection of gastric cancer in intermediate\u2010risk countries. However, formal comparative analyses with unscreened populations are lacking, and most survival and mortality data originate from Chinese studies, limiting generalizability. Nevertheless, economic evaluations suggest implementing endoscopic screening\u2014especially when integrated with colorectal screening or guided by risk stratification\u2014could be a feasible and effective strategy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>PROSPERO\u2014CRD42024502174<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ueg2.70084","type":"journal-article","created":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T14:54:11Z","timestamp":1754146451000},"page":"1715-1729","source":"Crossref","is-referenced-by-count":6,"title":["Effectiveness of Gastric Cancer Endoscopic Screening in Intermediate\u2010Risk Countries\u2014A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9242-1560","authenticated-orcid":false,"given":"M. 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