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CC BY 4.0 · Endosc Int Open
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   Division of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Shinagawa-ku, Japan

  • Yoshiaki Kimoto 

    2   Division of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Shinagawa-ku, Japan (Ringgold ID: RIN13635)

  • Etsuko Yamabe

    3   Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Shinagawa, Japan (Ringgold ID: RIN13635)

  • Miuzen Kanamori

    3   Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Shinagawa, Japan (Ringgold ID: RIN13635)

  • Susumu Banjoya

    4   Gastroenterology, NTT Medical Center Tokyo, Shinagawa-ku, Japan

  • Tomoya Kimura

    5   Gastrointestinal endoscopy, NTT Medical Center Tokyo, Shinagawa-ku, Japan

  • Koichi Furuta

    5   Gastrointestinal endoscopy, NTT Medical Center Tokyo, Shinagawa-ku, Japan

  • Shinya Nagae

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

  • Hiroshi Yamazaki

    7   Gastrointestinal endoscopy, NTT Medical Center Tokyo, Shinagawa-ku, Japan (Ringgold ID: RIN13635)

  • Nao Takeuchi 

    8   Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan

  • Shunya Takayanagi

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

  • Takafumi Konishi

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

  • Yuki Kano

    11   Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Shinagawa, Japan (Ringgold ID: RIN13635)

  • Kohei Ono

    12   Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Shinagawa-ku, Japan

  • Ryoju Negishi

    13   nr19790506@gmail.com, Itabashi Chuo Medical Center, Itabashi, Japan (Ringgold ID: RIN215674)

  • Yohei Minato

    14   Gastrointestinal endoscopy, NTT Medical Center Tokyo, Tokyo, Japan

  • Hideyuki Chiba 

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

  • Ken Ohata

    3   Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Shinagawa, Japan (Ringgold ID: RIN13635)
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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 6–14% 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 NBI (65.3%). Mean tumor diameter was 13.4 mm. While 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 BELT (Boundary Equal Lesion Trends). When detecting one lesion, considering BELT is essential.



Publication History

Received: 05 June 2025

Accepted after revision: 14 January 2026

Accepted Manuscript online:
18 January 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/).

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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 ; 0: a27891092.
DOI: 10.1055/a-2789-1092