Gastric cancer (GC) presents with variable incidence across the globe, which is translated to different screening approaches. Various guidelines attempt to present the optimal strategies for GC and premalignant conditions management; however, it is not recorded whether endoscopists comply with these recommendations. This study aimed to illustrate the current screening practices, adherence to guidelines, and variability in GC management among different countries.

A web-based cross-sectional survey of 28 items was distributed to various countries by individuals who were members of either World Endoscopy Organization (WEO) Emerging Stars or European Society of Gastrointestinal Endoscopy Young Endoscopists (EYE) Committee through September 2025. Questions about endoscopists’ status, screening and sampling for GC and premalignant lesions during esophagogastroduodenoscopy (EGD), post-diagnosis surveillance, counseling and treatment policies were included. Data were analyzed using descriptive statistics, and potential associations were investigated using chi-square test and multi-nominal regression analysis. Statistical significance was set at a p-value £ 0.005.

Eight hundred and twenty physicians from 20 countries participated in this questionnaire-based survey. The majority of them were Europeans (62.8%), but endoscopists from every continent were included. Age-standardized rate (ASR) of GC was <10 per 100,000 person-years in all of the included countries, except for Japan, according to the GLOBOCAN 2022 records. In South America, a variety of answers about the existence of formal GC screening programs was recorded, ranging from 20% to 35%. EGD is performed at a high rate (18.2-50%) regardless of a clear indication in several countries (Italy, Kenya, Brazil). Considering the quality of service, although high-definition equipment with virtual chromoendoscopy is available in every country, in some of them (Kenya, Serbia, Greece, Brazil and other Latin American countries) a high percentage of endoscopists (20-75%) only has access to conventional white light endoscopes. Likewise, expert upper GI pathologist is readily available for less than 50% of endoscopists in 11 out of 20 countries. Chi-square test indicated that the regional ASR, level of training, professional status and working place were associated with the different practices of physicians in GC surveillance. In the multi-nominal analyses, the country of practicing and the dedicated training in EGD and chromoendoscopy were more commonly associated with the differences in screening strategies, adherence to guidelines, endoscopy process and quality indicators. Contrariwise, endoscopists’ age, current status (supervised or independent trainee or fully competent endoscopist) and institution of practicing (public, academic or private sector) were not significantly associated with the investigated parameters.

Despite the existence of established guidance on GC screening and premalignant lesions management, there is a broad heterogeneity in the applied practices across the globe mainly associated with the country of practicing and the specialized training in upper GI endoscopy. These findings might be affected by the design of the study and the different number of physicians per country who answered the questionnaire. Therefore, national endoscopy societies are encouraged to record their internal variances to achieve uniform policies and compliance to the guidelines for GC and premalignant conditions management.