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

## TL;DR

This study finds that multiple early gastric cancers often share similar features and appear in the same region of the stomach, a pattern named BELT.

## Contribution

The study introduces the concept of 'boundary equal lesion trends (BELT)' to describe the spatial and pathological similarities of synchronous gastric lesions.

## Key findings

- Synchronous lesions often share location, morphology, and histology along the stomach's short axis.
- Most lesions were located in the lower/middle stomach, were differentiated, and showed brownish coloration on narrow-band imaging.
- The survival rate was 94.8%, with high concordance in clinicopathological features between primary and secondary lesions.

## Abstract

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.

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.

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).

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.