Effectiveness of Gastric Cancer Endoscopic Screening in Intermediate-Risk Countries, a Systematic Review and Meta-Analysis

BackgroundGastric 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. ObjectiveThis systematic review and meta-analysis aimed to evaluate the effectiveness and cost-effectiveness of endoscopic screening for gastric cancer in these countries. DesignA 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 registration number at PROSPERO is CRD42024502174. ResultsThirty-two studies met inclusion criteria--24 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 < 0.001) and early-stage gastric cancer among neoplasms (73.6%, p < 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. ConclusionsEndoscopic 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. KEY MESSAGESO_ST_ABSWhat is already known on this topicC_ST_ABSEndoscopic screening reduces gastric cancer mortality in high-risk countries. Evidence in intermediate-risk settings remains limited. What this study addsThis review shows that endoscopic screening improves early detection and gastric cancer prognosis in intermediate-risk countries and is cost-effective in several models. How this study might affect research, practice or policyFindings support implementing screening where cost-effectiveness is demonstrated, aligning with ESGE MAPS III recommendations.