Patterns of upper endoscopy use prior to gastric cancer diagnosis among high-risk populations.

11192 Background: Gastric cancer is frequently diagnosed at advanced stages in the United States, contributing to poor survival. Although several populations carry elevated risk, real-world patterns of upper endoscopic evaluation before gastric cancer diagnosis remain poorly characterized. Understanding pre-diagnostic endoscopy utilization may identify gaps in care and inform future evaluation strategies. Methods: A retrospective cohort study using Epic SlicerDicer identified adults ≥18 years diagnosed with gastric adenocarcinoma at Tufts Medical Center between January 2021 and January 2026. Gastric cancer was identified by ICD-10 codes, excluding patients with prior disease. Upper endoscopy (EGD) performed 6–36 months before diagnosis was assessed overall and across high-risk subgroups. EGDs within 6 months were excluded to distinguish pre-diagnostic from index diagnostic procedures. High-risk features were defined by the 2025 AGA Clinical Practice Update and included Asian race, Hispanic ethnicity, interpreter requirement, and prior Helicobacter pylori infection, gastric intestinal metaplasia (GIM), or chronic atrophic gastritis (CAG). Rates of pre-diagnostic EGD utilization were described overall and by subgroup. Results: Among 258 patients diagnosed with gastric adenocarcinoma, 77 (29.8%) presented with metastatic disease. Overall, 118 patients (45.7%) underwent EGD 6–36 months before diagnosis, while approximately half had their first documented EGD at the time of cancer diagnosis. Rates were similar across racial groups: White (45.3%), Asian (46.3%), Black (43.8%), and Other (45.7%). Utilization was higher among Hispanic versus non-Hispanic patients (57.7% vs 46.2%) and among those requiring interpreter services (51.8% vs 47.0%). Patients with gastric precursor conditions (34.1%) had similar rates of pre-diagnostic EGD (52.3%), including prior H. pylori infection (40.0%), GIM (63.3%), and CAG (55.0%). Of 140 patients without pre-diagnostic EGD, 39 (27.9%) underwent colonoscopy alone, indicating access to endoscopic care without concurrent EGD. Conclusions: Most upper endoscopies occurred near the time of cancer diagnosis, suggesting predominantly diagnostic rather than preventive evaluation. Even among patients with recognized risk factors and gastric precursor conditions, only about half underwent prior upper endoscopic assessment. Colonoscopy without concurrent EGD highlights gaps in integrated, risk-based gastrointestinal cancer prevention and an opportunity to improve earlier recognition of gastric cancer in high-risk populations. Upper endoscopy use before gastric cancer diagnosis. High-Risk Feature Total (N) Total (%) % w/ EGD (6–36 mo) Overall population 258 — 45.7 Asian race 67 26.0 46.3 Hispanic ethnicity 26 10.1 57.7 Requires interpreter 56 21.7 51.8 H. pylori infection 35 13.6 40.0 GIM 60 23.3 63.3 CAG 20 7.8 55.0 Any H. pylori , GIM, or CAG 88 34.1 52.3