{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T11:09:26Z","timestamp":1771931366079,"version":"3.50.1"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T00:00:00Z","timestamp":1770681600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Peri-endoscopic submucosal dissection missed early gastric cancers (peri-ESD MEGCs), defined as ESD-indicated lesions overlooked during pre-ESD diagnostic workup or post-ESD surveillance, may arise from deficiencies at any procedural phase (preparation, observation, diagnosis, or sampling). To address this, we developed a temporal-procedural bidirectional assessment protocol specifically targeting peri-ESD MEGCs, aiming to optimize endoscopic quality and prevent diagnostic omissions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this retrospective cohort study, 1,011 EGC lesions treated with endoscopic submucosal dissection (ESD) between 2017 and 2024 were analyzed. The primary analysis defined the MEGC time window as 24 months. Peri-ESD MEGCs were stratified into two temporal phases, pre-ESD examination vs. post-ESD surveillance, and four etiological categories, inadequate preparation, inadequate observation, diagnosis error, and sampling error, for each endoscopic cause of MEGC. To assess the robustness of our findings, a sensitivity analysis was performed by redefining the MEGC time window as 12 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 94 peri-ESD MEGCs, pre-ESD MEGCs (n=52) predominantly demonstrated inadequate observation (51.9%), which was associated with greater curvature location (OR: 5.45; 95% CI: 1.76\u201316.91), nonuse of near-focus narrow-band imaging (NF-NBI, OR: 16.78; 95% CI: 5.50\u201351.26), and severe intestinal metaplasia (OR: 3.84; 95% CI: 1.09\u201313.52). Post-ESD MEGCs (n=42) predominantly demonstrated a diagnosis error (52.4%), correlated with trainees (OR: 3.53; 95% CI: 1.06\u201311.68), small lesions (&amp;lt;15 mm, OR: 3.83; 95% CI: 1.10\u201313.36), nonuse of NF-NBI (OR: 17.44; 95% CI: 4.81\u201363.17), and severe atrophic gastritis (OR: 7.78; 95% CI: 1.91\u201331.20). The sensitivity analysis using a 12-month MEGC time window yielded results consistent with the primary analysis, demonstrating the robustness of the identified risk factors for peri-ESD missed lesions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Optimizing peri-ESD gastroscopic observation (via NF-NBI) and post-ESD diagnostic accuracy (through operator training) could significantly reduce peri-ESD MEGCs, particularly those reflecting characteristics of ESD-eligible lesions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1745307","type":"journal-article","created":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T05:30:29Z","timestamp":1770701429000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Optimizing endoscopic detection of early gastric cancer: stratification and preventive strategies for Peri-ESD diagnostic oversights"],"prefix":"10.3389","volume":"16","author":[{"given":"Lei","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Endoscopy, the Fourth Hospital of Hebei Medical University","place":["Shijiazhuang, Hebei, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nana","family":"An","sequence":"additional","affiliation":[{"name":"Department of Endoscopy, the Fourth Hospital of Hebei Medical University","place":["Shijiazhuang, Hebei, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiuli","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Endoscopy, the Fourth Hospital of Hebei Medical University","place":["Shijiazhuang, Hebei, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenqian","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Endoscopy, the Fourth Hospital of Hebei Medical University","place":["Shijiazhuang, Hebei, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juntao","family":"Lu","sequence":"additional","affiliation":[{"name":"Laboratory of Pathology, Hebei Cancer Institute, the Fourth Hospital of Hebei Medical University","place":["Shijiazhuang, Hebei, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Limian","family":"Er","sequence":"additional","affiliation":[{"name":"Department of Endoscopy, the Fourth Hospital of Hebei Medical University","place":["Shijiazhuang, Hebei, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,10]]},"reference":[{"key":"B1","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1111\/den.13883","article-title":"Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer (second edition)","volume":"33","author":"Ono","year":"2021","journal-title":"Dig Endosc."},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1007\/s10120-017-0704-y","article-title":"A non-randomized confirmatory trial of an expanded indication for endoscopic submucosal dissection for intestinal-type gastric cancer (cT1a): the Japan Clinical Oncology Group study (JCOG0607)","volume":"21","author":"Hasuike","year":"2018","journal-title":"Gastric Cancer."},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/s0016-5085(15)31920-x","article-title":"Surveillance strategy based on the incidence and patterns of recurrence after curative endoscopic submucosal dissection for early gastric cancer","volume":"47","author":"Min","year":"2015","journal-title":"Endoscopy."},{"key":"B4","doi-asserted-by":"publisher","first-page":"628","DOI":"10.1016\/j.gie.2016.03.1404","article-title":"Incidence and impact of scheduled endoscopic surveillance on recurrence after curative endoscopic resection for early gastric cancer","volume":"84","author":"Hahn","year":"2016","journal-title":"Gastrointest Endosc."},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2021.11.050","article-title":"Second gastric cancer after curative endoscopic resection of differentiated-type early gastric cancer: post-hoc analysis of a single-arm confirmatory trial","volume":"95","author":"Yoshida","year":"2022","journal-title":"Gastrointest Endosc."},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1097\/MCG.0b013e31825c0b69","article-title":"How can we predict the presence of missed synchronous lesions after endoscopic submucosal dissection for early gastric cancers or gastric adenomas","volume":"47","author":"Yoo","year":"2013","journal-title":"J Clin Gastroenterol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1111\/j.1443-1661.2012.01339.x","article-title":"Missed synchronous gastric neoplasm with endoscopic submucosal dissection for gastric neoplasm: experience in our hospital","volume":"25","author":"Kim","year":"2013","journal-title":"Dig Endosc."},{"key":"B8","first-page":"49","article-title":"Expert Consensus Opinion on standardized Endoscopic resection of early gastric Cancer (2018, Beijing)","volume":"5","author":"Linghu","year":"2018","journal-title":"Chin J Gastrointestinal Endoscopy."},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1055\/s-2002-33220","article-title":"A defoaming agent should be used with pronase premedication to improve visibility in upper gastrointestinal endoscopy","volume":"34","author":"Kuo","year":"2002","journal-title":"Endoscopy."},{"key":"B10","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1055\/s-0028-1098086","article-title":"An endoscopic recognition of the atrophic border and its significance in chronic gastritis","volume":"1","author":"Kimura","year":"1969","journal-title":"Endoscopy."},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1080\/00365520410009645","article-title":"Correlations of hemoglobin index (IHb) of gastric mucosa with Helicobacter pylori (H. pylori) infection and inflammation of gastric mucosa","volume":"39","author":"Uchiyama","year":"2004","journal-title":"Scand J Gastroenterol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1055\/s-0042-109049","article-title":"Linked color imaging improves endoscopic diagnosis of active Helicobacter pylori infection","volume":"4","author":"Dohi","year":"2016","journal-title":"Endosc Int Open"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2020.599218","article-title":"Accuracy of endoscopic diagnosis of helicobacter pylori based on the kyoto classification of gastritis: A multicenter study","volume":"10","author":"Zhao","year":"2020","journal-title":"Front Oncol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.27667","article-title":"Assessment of outcomes from 1-year surveillance after detection of early gastric cancer among patients at high risk in Japan","volume":"5","author":"Yamamoto","year":"2022","journal-title":"JAMA Netw Open"},{"key":"B15","doi-asserted-by":"publisher","first-page":"735","DOI":"10.1016\/j.gie.2023.02.024","article-title":"Endoscopic causes and characteristics of missed gastric cancers after endoscopic submucosal dissection","volume":"98","author":"Shimada","year":"2023","journal-title":"Gastrointest Endosc."},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1007\/s00535-020-01734-3","article-title":"Near-focus magnification and second-generation narrow-band imaging for early gastric cancer in a randomized trial","volume":"55","author":"Kakushima","year":"2020","journal-title":"J Gastroenterol"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1111\/jgh.15109","article-title":"Narrowband imaging with near-focus magnification for discriminating the gastric tumor margin before endoscopic resection: A prospective randomized multicenter trial","volume":"35","author":"Kim","year":"2020","journal-title":"J Gastroenterol Hepatol"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.4103\/njcp.njcp_1548_21","article-title":"Gastric intestinal metaplasia: Long-term follow-up results","volume":"25","author":"Rakici","year":"2022","journal-title":"Niger J Clin Pract"},{"key":"B19","doi-asserted-by":"publisher","first-page":"298","DOI":"10.1007\/s10120-022-01361-2","article-title":"Risk assessment of metachronous gastric cancer development using OLGA and OLGIM systems after endoscopic submucosal dissection for early gastric cancer: a long-term follow-up study","volume":"26","author":"Na","year":"2023","journal-title":"Gastric Cancer."},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1111\/den.12032","article-title":"Endoscopic diagnosis of gastric intestinal metaplasia: a prospective multicenter study","volume":"25","author":"Fukuta","year":"2013","journal-title":"Dig Endosc."},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.4021\/gr357w","article-title":"Predictability of gastric intestinal metaplasia by mottled patchy erythema seen on endoscopy","volume":"4","author":"Nagata","year":"2011","journal-title":"Gastroenterol Res"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0312385","article-title":"Analysis of clinicopathological factors associate with the visibility of early gastric cancer in endoscopic examination and usefulness of linked color imaging: A multicenter prospective study","volume":"19","author":"Fukuda","year":"2024","journal-title":"PloS One"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-014-3384-z","article-title":"Risk factors of developing interval early gastric cancer after negative endoscopy","volume":"60","author":"Cho","year":"2015","journal-title":"Dig Dis Sci"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1393498","DOI":"10.3389\/fmed.2024.1393498","article-title":"Helicobacter pylori eradication following endoscopic resection might prevent metachronous gastric cancer: a systematic review and meta-analysis of studies from Japan and Korea","volume":"11","author":"Yu","year":"2024","journal-title":"Front Med (Lausanne)."},{"key":"B25","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1016\/j.gie.2011.08.030","article-title":"Long-term effect of Helicobacter pylori eradication on the development of metachronous gastric cancer after endoscopic resection of early gastric cancer","volume":"75","author":"Maehata","year":"2012","journal-title":"Gastrointest Endosc."},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1055\/s-0043-110076","article-title":"Gastric superficial neoplasia: high miss rate but slow progression","volume":"5","author":"Shimodate","year":"2017","journal-title":"Endosc Int Open"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1111\/jgh.15751","article-title":"Prevalence of Helicobacter pylori infection in China: A systematic review and meta-analysis","volume":"37","author":"Ren","year":"2022","journal-title":"J Gastroenterol Hepatol"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.12998\/wjcc.v8.i11.2173","article-title":"Epidemiological investigation of Helicobacter pylori infection in elderly people in Beijing","volume":"8","author":"Zhu","year":"2020","journal-title":"World J Clin Cases."},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1002\/jgh3.70232","article-title":"Diagnosis, treatment patterns and eradication success for helicobacter pylori infections in China: A retrospective observational real-world study","volume":"9","author":"Xu","year":"2025","journal-title":"JGH Open"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-024-10970-0","article-title":"Risk factors of missed early gastric cancer in endoscopic resected population: a retrospective, case-control study","volume":"38","author":"Zhang","year":"2024","journal-title":"Surg Endosc."},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1111\/1751-2980.13061","article-title":"Feasibility of standardized procedures of white light gastroscopy for clinical practice: A multicenter study in China","volume":"22","author":"Wang","year":"2021","journal-title":"J Dig Dis"},{"key":"B32","doi-asserted-by":"publisher","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":"Kato","year":"2013","journal-title":"Gut."},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1136\/gut.47.5.618","article-title":"Natural history of early gastric cancer: a non-concurrent, long term, follow up study","volume":"47","author":"Tsukuma","year":"2000","journal-title":"Gut."}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1745307\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T10:20:36Z","timestamp":1771928436000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1745307\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,10]]},"references-count":33,"alternative-id":["10.3389\/fonc.2026.1745307"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1745307","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,10]]},"article-number":"1745307"}}