{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T23:53:10Z","timestamp":1791589990450,"version":"4.3.4"},"reference-count":26,"publisher":"Georg Thieme Verlag KG","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endoscopy"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>There is currently no consensus on long-term risk stratification for metachronous gastric neoplasms (MGNs) occurring beyond 5 years following endoscopic submucosal dissection (ESD). This study aimed to investigate the time-dependent changes in predictive factors for MGN after curative ESD for early gastric cancer (EGC) and analyze the clinicopathological features of late MGNs.<\/jats:p>\n                  <jats:p>We retrospectively reviewed patients who underwent ESD for early gastric neoplasms between March 2005 and June 2020. MGN was defined as a new gastric neoplasm detected at a different site &gt;12 months after ESD. Survival data were collected and analyzed using multivariable and time-split Cox hazard regression models.<\/jats:p>\n                  <jats:p>Among 5571 patients treated with ESD, 876 were included, with a median follow-up of 58 months. The cumulative incidence of MGN was 10.8% at 5 years and continued to accumulate beyond 5 years (26.7% at 10 years). All MGNs were stage I and there was no gastric cancer-related mortality. Cox regression analysis identified family history of gastric cancer (adjusted hazard ratio [aHR] 2.12, 95%CI 1.32\u20133.41) and extensive intestinal metaplasia (aHR 6.50, 95%CI 3.73\u201311.36) as independent predictors of MGN. Histological upgrade was not associated with MGN during the first 5 years, but emerged as a significant risk factor in the late period (interaction P = 0.005).<\/jats:p>\n                  <jats:p>MGNs may develop even beyond 5 years following ESD with curative resection in patients with EGC. These findings highlight the long-term risk of MGN after ESD, providing a framework for clinical risk estimation.<\/jats:p>","DOI":"10.1055\/a-2936-0365","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T23:26:38Z","timestamp":1786404398000},"source":"Crossref","is-referenced-by-count":0,"title":["Long-term risk of metachronous gastric neoplasms after curative endoscopic submucosal dissection for early gastric cancer"],"prefix":"10.1055","author":[{"given":"Jong Sun","family":"Park","sequence":"first","affiliation":[{"name":"Ajou University School of Medicine, Korea (the Republic of)","place":["Suwon"],"department":["Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eunyoung Angela","family":"Lee","sequence":"first","affiliation":[{"name":"The University of Texas Health Science Center at Houston, Texas, United States","place":["Houston"],"department":["Neurology, McGovern Medical School"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji Hyun","family":"Park","sequence":"additional","affiliation":[{"name":"Ajou University Medical Center, Korea (the Republic of)","place":["Suwon"],"department":["Office of Biostatistics, Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bumhee","family":"Park","sequence":"additional","affiliation":[{"name":"Ajou University Medical Center, Korea (the Republic of)","place":["Suwon"],"department":["Office of Biostatistics, Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jong Hoon","family":"Park","sequence":"additional","affiliation":[{"name":"Ajou University School of Medicine, Korea (the Republic of)","place":["Suwon"],"department":["Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5039-8182","authenticated-orcid":false,"given":"Min Jae","family":"Yang","sequence":"additional","affiliation":[{"name":"Ajou University School of Medicine, Korea (the Republic of)","place":["Suwon"],"department":["Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2045-5099","authenticated-orcid":false,"given":"Sun Gyo","family":"Lim","sequence":"additional","affiliation":[{"name":"Ajou University School of Medicine, Korea (the Republic of)","place":["Suwon"],"department":["Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung Jae","family":"Shin","sequence":"additional","affiliation":[{"name":"Ajou University School of Medicine, Korea (the Republic of)","place":["Suwon"],"department":["Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung Soo","family":"Ahn","sequence":"additional","affiliation":[{"name":"Solve-it Rheumatology and Gastroenterology Clinic, Korea (the Republic of)","place":["Yongin"],"department":["Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7695-0828","authenticated-orcid":false,"given":"Gil Ho","family":"Lee","sequence":"additional","affiliation":[{"name":"Ajou University School of Medicine, Korea (the Republic of)","place":["Suwon"],"department":["Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3607-8120","authenticated-orcid":false,"given":"Choong-Kyun","family":"Noh","sequence":"additional","affiliation":[{"name":"Solve-it Rheumatology and Gastroenterology Clinic, Korea (the Republic of)","place":["Yongin"],"department":["Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,10,9]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1007\/s10120-025-01698-4","article-title":"Japanese gastric cancer treatment guidelines 2025 (7th edition)","volume":"29","author":"Japanese Gastric Cancer Association","year":"2026","journal-title":"Gastric Cancer"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.18457","article-title":"Global incidence and mortality of gastric cancer, 1980\u20132018","volume":"4","author":"MCS Wong","year":"2021","journal-title":"JAMA Netw Open"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"464","DOI":"10.5230\/jgc.2024.24.e41","article-title":"National Statistics of Endoscopic Submucosal Dissection for Early Gastric Cancer in Korea","volume":"24","author":"SH Lee","year":"2024","journal-title":"J Gastric Cancer"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1425","DOI":"10.1136\/gutjnl-2011-301647","article-title":"Scheduled endoscopic surveillance controls secondary cancer after curative endoscopic resection for early gastric cancer: a multicentre retrospective cohort study by Osaka University ESD study group","volume":"62","author":"M Kato","year":"2013","journal-title":"Gut"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"784","DOI":"10.1055\/s-0034-1392249","article-title":"Surveillance strategy based on the incidence and patterns of recurrence after curative endoscopic submucosal dissection for early gastric cancer","volume":"47","author":"BH Min","year":"2015","journal-title":"Endoscopy"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1113","DOI":"10.1055\/s-0034-1392484","article-title":"Long-term surveillance and treatment outcomes of metachronous gastric cancer occurring after curative endoscopic submucosal dissection","volume":"47","author":"S Abe","year":"2015","journal-title":"Endoscopy"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"781","DOI":"10.5009\/gnl240027","article-title":"Optimal surveillance of metachronous gastric lesion after endoscopic resection of early gastric cancer","volume":"18","author":"DC Joo","year":"2024","journal-title":"Gut Liver"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"470","DOI":"10.5946\/ce.2022.259","article-title":"The pattern of metachronous recurrence after endoscopic submucosal dissection for gastric adenocarcinoma and dysplasias","volume":"56","author":"S Suk","year":"2023","journal-title":"Clin Endosc"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"3901","DOI":"10.1007\/s00464-023-09889-9","article-title":"Metachronous gastric neoplasm beyond 5 years after endoscopic resection for early gastric cancer","volume":"37","author":"E Lee","year":"2023","journal-title":"Surg Endosc"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"504","DOI":"10.1055\/a-2529-5025","article-title":"Management of epithelial precancerous conditions and early neoplasia of the stomach (MAPS III): European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter and Microbiota Study Group (EHMSG) and European Society of Pathology (ESP) Guideline update 2025","volume":"57","author":"M Dinis-Ribeiro","year":"2025","journal-title":"Endoscopy"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1016\/j.gie.2023.03.030","article-title":"American Society for Gastrointestinal Endoscopy guideline on endoscopic submucosal dissection for the management of early esophageal and gastric cancers: methodology and review of evidence","volume":"98","author":"MA Al-Haddad","year":"2023","journal-title":"Gastrointest Endosc"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1053\/j.gastro.2024.11.001","article-title":"AGA clinical practice update on screening and surveillance in individuals at increased risk for gastric cancer in the United States: expert review","volume":"168","author":"SC Shah","year":"2025","journal-title":"Gastroenterology"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1512","DOI":"10.3390\/jcm12041512","article-title":"Effect of Helicobacter pylori eradication treatment on metachronous gastric neoplasm prevention following endoscopic submucosal dissection for gastric adenoma","volume":"12","author":"CK Noh","year":"2023","journal-title":"J Clin Med"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"253","DOI":"10.5946\/ce.2017.104","article-title":"Metachronous gastric cancer following curative endoscopic resection of early gastric cancer","volume":"51","author":"S Abe","year":"2018","journal-title":"Clin Endosc"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"515","DOI":"10.1055\/a-0808-3186","article-title":"Endoscopic grading of gastric intestinal metaplasia (EGGIM): a multicenter validation study","volume":"51","author":"G Esposito","year":"2019","journal-title":"Endoscopy"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1007\/s10120-011-0041-5","article-title":"Japanese classification of gastric carcinoma: 3rd English edition","volume":"14","author":"Japanese Gastric Cancer Association","year":"2011","journal-title":"Gastric Cancer"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"480","DOI":"10.1038\/s41416-020-0883-x","article-title":"Association between the National Cancer Screening Programme (NSCP) for gastric cancer and oesophageal cancer mortality","volume":"123","author":"JH Kim","year":"2020","journal-title":"Br J Cancer"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"635","DOI":"10.1016\/s0140-6736(20)31288-5","article-title":"Gastric cancer","volume":"396","author":"EC Smyth","year":"2020","journal-title":"Lancet"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"892","DOI":"10.1055\/a-1724-7378","article-title":"Risk factors for gastric metachronous lesions after endoscopic or surgical resection: a systematic review and meta-analysis","volume":"54","author":"R Ortig\u00e3o","year":"2022","journal-title":"Endoscopy"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"228","DOI":"10.5009\/gnl14472","article-title":"Risk factors for metachronous gastric neoplasms in patients who underwent endoscopic resection of a gastric neoplasm","volume":"10","author":"H Yoon","year":"2016","journal-title":"Gut Liver"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1002\/1097-0142(195309)6:5<963::AID-CNCR2820060515>3.0.CO;2-Q","article-title":"Field cancerization in oral stratified squamous epithelium; clinical implications of multicentric origin","volume":"6","author":"DP Slaughter","year":"1953","journal-title":"Cancer"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1136\/gutjnl-2014-307094","article-title":"Demonstration of the usefulness of epigenetic cancer risk prediction by a multicentre prospective cohort study","volume":"64","author":"K Asada","year":"2015","journal-title":"Gut"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"142","DOI":"10.5483\/bmbrep.2007.40.2.142","article-title":"Epigenetic field for cancerization","volume":"40","author":"T Ushijima","year":"2007","journal-title":"J Biochem Mol Biol"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1256","DOI":"10.1007\/s00464-013-3316-6","article-title":"Discrepancy between endoscopic forceps biopsy and endoscopic resection in gastric epithelial neoplasia","volume":"28","author":"H Lim","year":"2014","journal-title":"Surg Endosc"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"187","DOI":"10.5009\/gnl.2011.5.2.187","article-title":"Upgrade of lesions initially diagnosed as low-grade gastric dysplasia upon forceps biopsy following endoscopic resection","volume":"5","author":"CS Won","year":"2011","journal-title":"Gut Liver"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1007\/s00535-010-0289-2","article-title":"Endoscopic and histopathological characteristics suggesting the presence of gastric mucosal high grade neoplasia foci in cases initially diagnosed as gastric mucosal low grade neoplasia by forceps biopsy in Korea","volume":"46","author":"BH Min","year":"2011","journal-title":"J Gastroenterol"}],"container-title":["Endoscopy"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2936-0365.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T23:29:22Z","timestamp":1791588562000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2936-0365"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,10]]},"references-count":26,"URL":"https:\/\/doi.org\/10.1055\/a-2936-0365","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0013-726X","1438-8812"],"issn-type":[{"value":"0013-726X","type":"print"},{"value":"1438-8812","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,8,10]]},"published":{"date-parts":[[2026,8,10]]}}}