White Globe Appearance Is an Endoscopic Predictor of Metachronous Multiple Gastric Cancers.

White globe appearance (WGA) is a small white lesion with a globular shape identified during magnifying endoscopy with narrow-band imaging. However, the association between WGA and metachronous gastric cancer remains unclear. This study involved patients who underwent endoscopic submucosal dissection (ESD) for first-episode single gastric cancer at our institution between January 2012 and December 2018 and who had at least one endoscopic follow-up after resection. WGA-positive gastric cancer was defined by the presence of WGA, and metachronous gastric cancer was defined as new cancer arising at a different site ≥1 year after ESD. The primary endpoint was a comparison of the incidence of metachronous gastric cancers in patients with WGA-positive versus WGA-negative gastric cancer. Univariate and multivariate analyses were conducted using the following variables: WGA status, sex, age, and severe atrophy. In total, 160 WGA-positive and 284 WGA-negative gastric cancer cases were included. Metachronous gastric cancers were significantly more frequent in the WGA-positive group (p < 0.01). Univariate analysis identified Helicobacter pylori infection (p = 0.049), WGA positivity (p < 0.01), and a longer observation period (p < 0.01) as factors significantly associated with metachronous gastric cancers. In the multivariate analysis, only WGA positivity was a significant independent risk factor (p < 0.01). WGA may be a predictive marker for metachronous gastric cancers. In cases of WGA-positive gastric cancer, endoscopic follow-up should be conducted with heightened attention to the risk of metachronous lesions.