{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T12:44:20Z","timestamp":1768567460851,"version":"3.49.0"},"posted":{"date-parts":[[2025,4,7]]},"group-title":"Gastroenterology","reference-count":70,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2025,4,7]],"date-time":"2025-04-07T00:00:00Z","timestamp":1743984000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.medrxiv.org\/about\/FAQ#license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2025,4,7]]},"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 mortality worldwide, including in intermediate-risk countries. While endoscopic screening has proven effective in high-risk populations, its impact and economic value in intermediate-risk settings remain uncertain.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>This systematic review and meta-analysis aimed to evaluate the effectiveness and cost-effectiveness of endoscopic screening for gastric cancer in these countries.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>\n                    A systematic review and meta-analysis was conducted following a comprehensive search in Medline, Scopus, Embase, and Web of Science, covering studies published up to 30 September 2024. A random-effects meta-analysis was performed for effectiveness studies, and economic evaluations were synthesised narratively. The study\n                    <jats:bold>registration<\/jats:bold>\n                    number at PROSPERO is CRD42024502174.\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Thirty-two studies met inclusion criteria\u201424 on screening effectiveness and eight on cost-effectiveness. Across the 24 effectiveness studies, 404,159 individuals underwent upper endoscopic screening, which significantly increased detection of precancerous lesions (pooled effect size: 28%, p &lt; 0.001) and early-stage gastric cancer among neoplasms (73.6%, p &lt; 0.001). Screening was also associated with a 26.1% reduction in gastric cancer mortality and improved five-year survival (63.7% to 85.0%). Economic analyses suggested endoscopic screening is cost-effective in intermediate-risk settings, particularly when combined with colorectal cancer screening.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Endoscopic screening improves early detection and survival in intermediate-risk countries. Cost-effectiveness studies support its feasibility, especially when integrated with colorectal cancer screening or risk-stratified strategies.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>KEY MESSAGES<\/jats:title>\n                  <jats:sec>\n                    <jats:title>What is already known on this topic<\/jats:title>\n                    <jats:p>Endoscopic screening reduces gastric cancer mortality in high-risk countries. Evidence in intermediate-risk settings remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>What this study adds<\/jats:title>\n                    <jats:p>This review shows that endoscopic screening improves early detection and gastric cancer prognosis in intermediate-risk countries and is cost-effective in several models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>How this study might affect research, practice or policy<\/jats:title>\n                    <jats:p>Findings support implementing screening where cost-effectiveness is demonstrated, aligning with ESGE MAPS III recommendations.<\/jats:p>\n                  <\/jats:sec>\n                <\/jats:sec>","DOI":"10.1101\/2025.04.06.25325320","type":"posted-content","created":{"date-parts":[[2025,4,8]],"date-time":"2025-04-08T01:02:34Z","timestamp":1744074154000},"source":"Crossref","is-referenced-by-count":1,"title":["Effectiveness of Gastric Cancer Endoscopic Screening in Intermediate-Risk Countries \u2013 a Systematic Review and Meta-Analysis"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9242-1560","authenticated-orcid":false,"given":"B.","family":"Mourato","sequence":"first","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6980-3675","authenticated-orcid":false,"given":"N.","family":"Pratas","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0009-0006-0811-1444","authenticated-orcid":false,"given":"A","family":"Branco","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1023-245X","authenticated-orcid":false,"given":"R.","family":"Chan\u00e7a","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1406-4585","authenticated-orcid":false,"given":"I.","family":"Fronteira","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2101-0027","authenticated-orcid":false,"given":"R.","family":"Dinis","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9787-8175","authenticated-orcid":false,"given":"M.","family":"Areia","sequence":"additional","affiliation":[]}],"member":"54368","reference":[{"key":"2025041003450770000_2025.04.06.25325320v1.1","unstructured":"International Agency for Research on Cancer. 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