Opportunistic Upper Endoscopy at the Time of Screening Colonoscopy: Feasibility, Acceptability, and Patient Perspectives.

BACKGROUND AND AIMS: Gastric cancer is highly lethal due to late stage at discovery in the United States, yet no routine screening strategy exists. Opportunistic upper endoscopy (esophagogastroduodenoscopy [EGD]) performed during screening colonoscopy (concomitant EGD and routine colonoscopy [EGD-SC]) may provide a practical approach to early detection. We evaluated the feasibility, acceptability, patient perspectives, and diagnostic yield of EGD-SC. METHODS: In this single-center, open-label, single-arm prospective pilot study, adults aged 45 to 80 years scheduled for colonoscopy without prior EGD in the past 5 years were enrolled. Feasibility was assessed by enrollment, additional procedural time, and safety. Acceptability, patient perspectives, beliefs, motivators, barriers, and satisfaction were assessed using preprocedure and postprocedure surveys. Gastric biopsies were evaluated for precancerous gastric lesions. RESULTS: Of individuals contacted, 51.6% expressed interest and 26.6% enrolled (n = 50; median age 56; 48% male; 60% high risk). Median added time was 17 minutes (range, 9-26), with no complications. All respondents rated EGD-SC as satisfactory (n = 40, 100%) and 90% (n = 36) as acceptable; most preferred the combined procedure (n = 39, 97.5%) and would recommend it to family or friends (n = 37, 92.5%). Knowledge gaps were common: nearly half lacked awareness of gastric cancer risk factors; although 72% (n = 31) viewed screening as beneficial, only 23.3% (n = 10) perceived gastric cancer as severe, and none considered themselves highly susceptible. Diagnostic yield included Helicobacter pylori infection (n = 16, 32%), atrophic gastritis (n = 7, 14%), and intestinal metaplasia (n = 6, 12%), with higher prevalence among high-risk participants. CONCLUSION: EGD-SC is feasible, safe, and highly acceptable, with strong patient endorsement and meaningful detection of gastric cancer precursor lesions. Together, these results support risk-stratified EGD-SC as a promising and pragmatic strategy for gastric cancer prevention and early detection in the United States. This trial was registered at www.clinicaltrials.gov as NCT05566899.