Screening strategies for the early detection of non-cardia gastric cancer in low- to moderate-prevalence regions: Asia-Pacific gastroesophageal cancer congress consensus 2026.

BACKGROUND: Gastric cancer (GC) remains a major global health burden, and early detection is essential for improving patient outcomes. Although GC screening has been widely implemented in East Asian countries with a high disease burden, the optimal screening strategy for low- to moderate-prevalence regions remains unclear. To address this gap, the Asia Pacific Gastroesophageal Cancer Congress (APGCC) convened an international consensus meeting to develop evidence-based recommendations for improving the detection of non-cardia gastric cancer (NCGC). METHODS: The APGCC working group developed 11 clinical questions (CQs) addressing GC screening, with a particular focus on NCGC. For each CQ, assigned authors conducted literature reviews using PubMed and prepared evidence summaries and draft recommendations. Consensus was achieved through a two-round modified Delphi process involving 37 international voting members. RESULTS: The consensus recommendations addressed population-based screening, screening modalities, identification of high-risk individuals, quality indicators for esophagogastroduodenoscopy (EGD), image-enhanced endoscopy, and artificial intelligence-assisted endoscopy. Population-based endoscopic screening is not recommended in low- to moderate-prevalence regions because of insufficient evidence. However, if screening is performed, EGD is preferred over upper gastrointestinal series for the detection of early NCGC in asymptomatic individuals. The recommendations also emphasize the importance of high-quality endoscopic examinations, risk-stratified screening using serum biomarkers, and the appropriate integration of advanced endoscopic technologies. CONCLUSIONS: These APGCC consensus recommendations provide practical guidance for improving the early detection of NCGC in low- to moderate-prevalence regions. This consensus also highlights important evidence gaps and establishes a framework for future research and the development of region-specific GC screening strategies.