{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T16:04:48Z","timestamp":1784563488351,"version":"3.55.0"},"reference-count":20,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"unspecified","delay-in-days":19,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Capital Medical University Natural Science Foundation","award":["PYZ25088"],"award-info":[{"award-number":["PYZ25088"]}]},{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","award":["2022YFC2404404"],"award-info":[{"award-number":["2022YFC2404404"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","award":["2022YFC3602100"],"award-info":[{"award-number":["2022YFC3602100"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","award":["2022YFC3602103"],"award-info":[{"award-number":["2022YFC3602103"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82027801"],"award-info":[{"award-number":["82027801"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,6,30]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To systematically summarise recent evidence on endoscopic biopsy for gastric ulcer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Systematic review of clinical studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data sources<\/jats:title>\n                    <jats:p>PubMed, Embase, Cochrane Library, Web of Science, CNKI and CiNii Research were searched for studies published from 2015 to May 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Eligibility criteria<\/jats:title>\n                    <jats:p>Original studies involving adults with endoscopically diagnosed gastric ulcers or ulcerative gastric lesions directly informing biopsy strategy were eligible if they evaluated biopsy timing, number, site or related diagnostic outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data extraction and synthesis<\/jats:title>\n                    <jats:p>Two reviewers independently screened studies, extracted data and assessed risk of bias using the Newcastle\u2013Ottawa Scale. Owing to substantial clinical and methodological heterogeneity, findings were synthesised narratively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Seven studies were included and grouped into four domains: biopsy timing, biopsy number, biopsy site and safety. Available data suggested that most malignancies may be identifiable at the initial endoscopy examination although repeat biopsy during ulcer healing or scarring might still detect some missed cancers. Evidence on the biopsy site remained limited and inconsistent, and findings from healed-phase ulcers further suggested that the anatomical site alone may be insufficient to guide biopsy strategy. Available studies also indicated that four well-targeted biopsies may be adequate for some depressed or polypoid lesions whereas more extensive sampling might be needed for infiltrative or otherwise suspicious lesions. Limited safety data did not show a clear increase in adverse events with broader biopsy strategies or the biopsy of stabilised bleeding ulcers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Contemporary evidence on endoscopic biopsy for gastric ulcers remains limited, heterogeneous and largely observational. Available data suggest that biopsy at initial endoscopy and adequate, lesion-targeted sampling may improve diagnostic yield, while follow-up and intensive sampling should be individualised according to endoscopic appearance, histological findings and clinical suspicion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD420251157851.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-119032","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T15:30:25Z","timestamp":1784561425000},"page":"e119032","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Endoscopic biopsy strategies for gastric ulcers: an updated systematic review"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-2161-468X","authenticated-orcid":false,"given":"Menghan","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University; State Key Laboratory of Digestive Health; National Clinical Research Center for Digestive Disease; Beijing Key Laboratory of Early Gastrointestinal Cancer Medicine and Medical Devices, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yijun","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University; State Key Laboratory of Digestive Health; National Clinical Research Center for Digestive Disease; Beijing Key Laboratory of Early Gastrointestinal Cancer Medicine and Medical Devices, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingshan","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University; State Key Laboratory of Digestive Health; National Clinical Research Center for Digestive Disease; Beijing Key Laboratory of Early Gastrointestinal Cancer Medicine and Medical Devices, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kun","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University; State Key Laboratory of Digestive Health; National Clinical Research Center for Digestive Disease; Beijing Key Laboratory of Early Gastrointestinal Cancer Medicine and Medical Devices, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenhai","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University; State Key Laboratory of Digestive Health; National Clinical Research Center for Digestive Disease; Beijing Key Laboratory of Early Gastrointestinal Cancer Medicine and Medical Devices, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,20]]},"reference":[{"key":"2026072008301193000_16.7.e119032.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annonc.2022.07.004"},{"key":"2026072008301193000_16.7.e119032.2","doi-asserted-by":"publisher","DOI":"10.1007\/BF01535778"},{"key":"2026072008301193000_16.7.e119032.3","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1016\/j.cgh.2023.10.034","article-title":"AGA Clinical Practice Update on High-Quality Upper Endoscopy: Expert Review","volume":"22","author":"Nagula","year":"2024","journal-title":"Clin Gastroenterol Hepatol"},{"key":"2026072008301193000_16.7.e119032.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2015.03.1967"},{"key":"2026072008301193000_16.7.e119032.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2009.11.026"},{"key":"2026072008301193000_16.7.e119032.6","first-page":"1137","article-title":"Guidelines for diagnosis and treatment of gastric cancer: 2022 edition","volume":"21","year":"2022","journal-title":"Chin J Dig Surg"},{"key":"2026072008301193000_16.7.e119032.7","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.g7647","article-title":"Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation","volume":"350","author":"Shamseer","year":"2015","journal-title":"BMJ"},{"key":"2026072008301193000_16.7.e119032.8","unstructured":"Ottawa Hospital Research Institute . 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