Introduction
Gastric cancer is a major cause of cancer-related mortality, mainly due to late-stage diagnosis. In Europe, outcomes remain suboptimal, highlighting the need for effective early detection strategies1. Endoscopic screening, including combined upper endoscopy and colonoscopy, may improve early detection and optimise healthcare resources by reducing patient burden2. However, its success depends not only on clinical effectiveness but also on patient experience, acceptability, and willingness to participate3–5.
Participation in screening programmes is influenced by perceived burden, including discomfort, invasiveness, and logistical factors5,6. Patient-reported experience is essential to identify barriers and facilitators to uptake and guide patient-centred implementation6, particularly in real-world European screening settings where evidence remains limited.
Within the TOGAS (TOwards GAStric Cancer Screening Implementation in Europe) project, combined screening approaches are being explored across multiple European settings3.
Aims & Methods
This study aimed to evaluate acceptability, patient-reported experience, and willingness for future participation in combined upper endoscopy and colonoscopy within TOGAS Pilot Study 2.
We conducted a cross-sectional survey among individuals invited to a same-session upper endoscopy and colonoscopy screening programme across 8 European countries (Lithuania, France, Portugal, Netherlands, Ireland, Germany, Latvia, and Spain). Data were collected using anonymous questionnaires assessing sociodemographic characteristics, prior screening history, adequacy of information, procedural experience, and willingness for future participation. Descriptive statistics and chi-square tests were used (p<0.05).
Results
Participants were predominantly aged 60-69 years, with balanced gender distribution. Awareness of gastric cancer risk factors was low (17.3%), and 82.1% had never undergone prior gastric cancer testing. Main motivations for combined procedures were same-day testing preference (50.1%), desire to be checked (32.3%) and physician recommendation (26.3%). Acceptability was high, with 96.7% reporting adequate pre-procedure information and 94.8% rating it good, very good or excellent. Procedural tolerance was favourable, with 77.4% reporting no pain or discomfort and 4.9% moderate or severe discomfort.
Patient-reported experience was positive, with 92.3% rating post-procedure explanations as good, very good or excellent. Overall, 72.2% were very satisfied with the care received, 56.1% would strongly recommend the combined procedures, and 25.2% would be willing to repeat them, indicating variability across satisfaction, recommendation and intention to repeat. However, 93.2% expressed willingness to participate in a screening programme like TOGAS, which was associated with better pre-procedure information and clearer explanations provided, younger age, female gender, and higher education (all p<0.05). Procedural discomfort was not associated with willingness to participate in future screening.
Conclusion
Combined upper endoscopy and colonoscopy was highly acceptable in this multinational European cohort, with positive patient-reported experience, high overall satisfaction, and willingness to participate in future screening programmes. However, willingness to repeat or recommend the combined procedure was lower, suggesting a gap between experience and behavioural intention. Procedural discomfort was infrequent and did not influence future intentions. In contrast, information quality appears to be a key driver of screening acceptance and engagement.
References
1. Sundar, R. et al. Gastric cancer. The Lancet 405, 2087–2102 (2025).
2. Planade, O. et al. Systematic upper endoscopy concomitant with colonoscopy performed within the colorectal cancer screening program: Impact on the patients’ management. Clin. Res. Hepatol. Gastroenterol. 45, 101501 (2021).
3. Leja, M. Where are we with gastric cancer screening in Europe in 2024? Gut 73, 2074–2082 (2024).
4. Mourato, M. B. et al. Effectiveness of Gastric Cancer Endoscopic Screening in Intermediate‐Risk Countries—A Systematic Review and Meta‐Analysis. United European Gastroenterol. J. 13, 1715–1729 (2025).
5. Silva, J. C., Dinis-Ribeiro, M., Tavares, F. & Libânio, D. Exploring the perceived risk of complications in endoscopic screening procedures. GE Port. J. Gastroenterol. 1–17 (2024) doi:10.1159/000543180.
6. Hatamian, S., Etesam, S., Mazidimoradi, A., Momenimovahed, Z. & Salehiniya, H. The Barriers and Facilitators of Gastric Cancer Screening: a Systematic Review. J. Gastrointest. Cancer 52, 839–845 (2021).
