{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T23:47:10Z","timestamp":1782431230669,"version":"3.54.5"},"reference-count":16,"publisher":"Georg Thieme Verlag KG","issue":"CP","license":[{"start":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T00:00:00Z","timestamp":1781308800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endosc Int Open"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Background\/Aims The eradication of Helicobacter pylori reduces gastric cancer risk; however, the rate of metachronous development (MD) after endoscopic resection for early gastric cancer (EGC) is 1\u20134% annually. Hence, we evaluated various risk factors for MD after endoscopic submucosal dissection (ESD), specifically bile reflux, which has received limited clinical attention.<\/jats:p>\n                  <jats:p>Methods\/Results We retrospectively analyzed clinical data from 454 patients who underwent ESD for EGC between 2010 and 2018. MD was defined as the presence of a newly developed lesion more than 12 months after ESD. Bile reflux was assessed under standardized second-look endoscopy the day after ESD. During a median follow-up of 34.3 months, MD was observed in 45 patients (9.9%). Multivariate analysis revealed older age, severe gastric mucosal atrophy, xanthoma, and bile reflux as independent risk factors for MD. The 5-year MD rate was significantly greater in the bile reflux group than in the control group (24.2% vs. 11.2%, p = 0.01). Notably, in the bile reflux group, MD was significantly more frequently observed in the antrum or lower gastric body (61.1% vs. 29.6%, p = 0.036). Diabetes mellitus was identified as an independent risk factor for bile reflux.<\/jats:p>\n                  <jats:p>Conclusions Bile reflux is a significant and independent risk factor for MD after ESD for EGC, particularly in gravity-dependent areas. Patients with bile reflux represent a high-risk subgroup requiring intensive endoscopic surveillance, such as every 6 months, to facilitate early detection of metachronous lesions.<\/jats:p>","DOI":"10.1055\/a-2892-7590","type":"journal-article","created":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T22:31:40Z","timestamp":1781389900000},"source":"Crossref","is-referenced-by-count":0,"special_numbering":"S","title":["Bile Reflux is a Risk Factor for Metachronous Development in Patients with Early Gastric Cancer"],"prefix":"10.1055","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-6899-6354","authenticated-orcid":false,"given":"Hiroki","family":"Murai","sequence":"additional","affiliation":[{"name":"Osaka Rosai Hospital, Japan","place":["Sakai"],"department":["Department of Gastroenterology and 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