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CC BY 4.0 · Endosc Int Open 2026; 14: a27891092
DOI: 10.1055/a-2789-1092
Original article

Second lesions located within the same belt-like region along the stomach's short axis as primary lesions: Boundary equal lesion trends

Authors

  • Toshifumi Iida 

    1   Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Shinagawa-ku, Japan

  • Yoshiaki Kimoto 

    1   Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Shinagawa-ku, Japan

  • Etsuko Yamabe

    1   Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Shinagawa-ku, Japan

  • Miuzen Kanamori

    1   Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Shinagawa-ku, Japan

  • Susumu Banjoya

    1   Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Shinagawa-ku, Japan

  • Tomoya Kimura

    1   Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Shinagawa-ku, Japan

  • Koichi Furuta

    1   Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Shinagawa-ku, Japan

  • Shinya Nagae

    2   Gastroenterology, Itabashi Chuo Medical Center, Itabashi, Japan (Ringgold ID: RIN215674)

  • Hiroshi Yamazaki

    1   Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Shinagawa-ku, Japan

  • Nao Takeuchi 

    1   Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Shinagawa-ku, Japan

  • Shunya Takayanagi

    3   Medicine, Haukeland University Hospital, Bergen, Norway (Ringgold ID: RIN60498)

  • Takafumi Konishi

    4   Department of Gastroenterology, Rinku General Medical Center, Izumisano, Japan (Ringgold ID: RIN36845)

  • Yuki Kano

    1   Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Shinagawa-ku, Japan

  • Kohei Ono

    1   Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Shinagawa-ku, Japan

  • Ryoju Negishi

    5   Itabashi Chuo Medical Center, Itabashi, Japan (Ringgold ID: RIN215674)

  • Yohei Minato

    1   Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Shinagawa-ku, Japan

  • Hideyuki Chiba 

    6   Gastroenterology, Omori Red Cross Hospital, Ota-Ku, Japan

  • Ken Ohata

    1   Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Shinagawa-ku, Japan
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Abstract

Background and study aims

Gastric adenoma and cancer are common in Asia, with early detection critical for prognosis. Synchronous multiple early gastric cancers (SMEGCs) occur in 6% to 14% of cases, but their clinicopathological characteristics remain unclear. This study analyzed synchronous multiple gastric neoplasms treated by endoscopic resection or surgery to aid early detection.

Patients and methods

Among 2,991 cases of early gastric cancer or adenoma diagnosed at our institution, 173 patients with 346 synchronous lesions (January 2016-March 2024) were analyzed. All lesions were mucosal or submucosal. Lesions were categorized as “1st” (larger) and “2nd” (smaller), and clinicopathological characteristics were compared using Chi-square and Fisher’s exact tests with Cramér’s V.

Results

Patients had a mean age of 73.2 years; 72.8% were male. Most lesions were in the lower/middle stomach, differentiated (92.2%), depressed (52.9%), and brownish on narrow-band imaging (65.3%). Mean tumor diameter was 13.4 mm. Although 1st lesions were larger, other features showed high concordance (≥ 0.25 Cramér’s V) in location, morphology, histology, invasion depth, and coloration. Survival was 94.8% (nine unrelated deaths).

Conclusions

Synchronous multiple gastric neoplasms tend to have similar endoscopic and histopathologic features and often occur within the same belt-like region along the short axis of the stomach. This pattern was named boundary equal lesions trends (BELT). When detecting one lesion, considering BELT is essential.

Keywords

Endoscopy Upper GI Tract - Endoscopic resection (ESD, EMRc, ...) - Malignant strictures - Diagnosis and imaging (inc chromoendoscopy, NBI, iSCAN, FICE, CLE) - GI surgery


Publication History

Received: 05 June 2025

Accepted after revision: 14 January 2026

Accepted Manuscript online:
18 January 2026

Article published online:
05 February 2026

© 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Bibliographical Record
Toshifumi Iida, Yoshiaki Kimoto, Etsuko Yamabe, Miuzen Kanamori, Susumu Banjoya, Tomoya Kimura, Koichi Furuta, Shinya Nagae, Hiroshi Yamazaki, Nao Takeuchi, Shunya Takayanagi, Takafumi Konishi, Yuki Kano, Kohei Ono, Ryoju Negishi, Yohei Minato, Hideyuki Chiba, Ken Ohata. Second lesions located within the same belt-like region along the stomach's short axis as primary lesions: Boundary equal lesion trends. Endosc Int Open 2026; 14: a27891092.
DOI: 10.1055/a-2789-1092
 

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