A systematic review and meta-analysis of incidence trends and risk factors for metachronous gastric lesions following endoscopic resection

Metachronous gastric lesions (MGLs) are a significant concern after endoscopic resection (ER) for precancerous lesions and early gastric cancers (EGCs). The follow-up strategy for the development of MGLs after ER remains unclear. The aim of this study was to compare the trend in the cumulative MGL incidence after ER and to identify risk factors of MGLs. We searched four databases (PubMed, Embase, Web of Science Core Collection and Cochrane Library) for studies reporting on patients who underwent ER, and performed meta-analysis. A dose-response analysis was performed to examine the association between follow-up time and cumulative MGL incidence after ER. Of the 423 studies initially retrieved, 18 studies were finally included in the meta-analysis. The overall cumulative MGL incidence after ER was 9.4% (95% confidence interval (CI) 7.2%−1.9%). The cumulative MGL incidence in China (5.4%, 95% CI: 4.1%−6.8%) was significantly lower than those in Korea (10.2%, 95% CI: 7.2%–13.5%) and Japan (9.0%, 95% CI: 7.0%–13.2%). Dose-response analysis showed that cumulative MGL incidence increased rapidly during 3–7 years follow-up after ER. Male gender (HR = 1.283, 95% CI: 1.029–1.601), older age (HR = 1.025, 95% CI: 1.010–1.040), <i>Helicobacter pylori</i> (<i>H. pylori</i>) infection (HR = 1.573, 95% CI: 1.048–2.362), severe intestinal metaplasia (IM) (HR = 3.423, 95% CI: 1.830–6.042) were significantly associated with MGLs after ER. Nearly 10% of patients develop MGLs after ER. Older age, persistent <i>H. pylori</i> infection, severe intestinal metaplasia, and male sex were independent risk factors. Given the increased incidence 3 year after ER, surveillance with intensified follow-up is necessary for high-risk patients.