Upper gastrointestinal endoscopic screening uptake and associated factors in East Asia: a systematic review and meta-analysis.

OBJECTIVE: To estimate the pooled uptake of upper gastrointestinal endoscopic screening uptake and to identify factors associated with screening uptake among populations eligible for upper gastrointestinal endoscopic screening. METHODS: A systematic review and meta-analysis was conducted to identify studies reporting the uptake of upper gastrointestinal endoscopic screening and factors associated with screening participation. The pooled uptake was calculated using the random-effects model. For influencing factors, pooled odds ratios (ORs) with 95% confidence intervals (CIs) were estimated. Heterogeneity was assessed using Cochran's Q test and the I2 statistic. Subgroup analyses, meta-regression, leave-one-out sensitivity analysis, and publication bias assessment were performed to evaluate the robustness of the findings. RESULTS: A total of 48 studies involving 119,913,685 participants were included in the meta-analysis of screening uptake. The pooled uptake of upper gastrointestinal endoscopic screening was 38% (95% CI: 28-48%), with substantial heterogeneity. Subgroup analyses showed that screening uptake differed significantly by country (p = 0.047) and sample size (p = 0.001). Meta-regression indicated that publication year and sample size were not significant moderators of screening uptake (all p > 0.05). Sensitivity analysis demonstrated that the pooled estimate remained stable after sequential omission of each study, and Egger's test did not indicate significant publication bias (p = 0.817). Among the 26 identified factors, 10 were included in the meta-analysis, and the remaining factors were summarized descriptively. The pooled results showed that female sex (OR = 1.16, 95% CI: 1.07-1.27), higher education (OR = 1.53, 95% CI: 1.35-1.74), occupational exposure to hazards (OR = 1.15, 95% CI: 1.08-1.23), drinking shallow water (OR = 1.32, 95% CI: 1.28-1.37), drinking deep well water (OR = 1.22, 95% CI: 1.05-1.40), a history of upper gastrointestinal diseases (OR = 1.94, 95% CI: 1.72-2.20), a family history of upper gastrointestinal cancer (OR = 1.50, 95% CI: 1.29-1.74), and a family history of cancer (OR = 1.57, 95% CI: 1.27-1.93) were associated with higher endoscopic screening uptake. In contrast, regular physical exercise (OR = 0.89, 95% CI: 0.81-0.97) and current smoking (OR = 0.86, 95% CI: 0.75-0.99) were associated with lower screening uptake. CONCLUSION: The uptake of upper gastrointestinal endoscopic screening remains suboptimal among screening-eligible populations. Screening participation appears to be influenced by socioeconomic factors, lifestyle factors, disease-related factors, cognitive factors, healthcare-related factors. These findings may inform targeted interventions to improve screening uptake and optimize the implementation of upper gastrointestinal cancer screening programs. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261279918, identifier CRD420261279918.