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Background  In Korea, where gastric cancer is highly prevalent, biennial endoscopy is recommended among individuals over 40. Even under regular screening, some are still diagnosed at advanced stages. We aimed to identify characteristics of interval gastric neoplasms (IGNs) with rapid progression.    Results  Newly-diagnosed gastric neoplasms detected in screening endoscopy between January 2004 and May 2016 were reviewed. Among them, those who had previous endoscopy within 2 years were enrolled. Endoscopic findings, family history of gastric cancer, smoking, and  H. pylori  status were analysed. Totally, 297 IGN cases were enrolled. Among them, 246 were endoscopically treatable IGN (ET-IGN) and 51 were endoscopically untreatable IGNs (EUT-IGN) by the expanded criteria for endoscopic submucosal dissection. Among EUT-IGNs, 78% were undifferentiated cancers (40/51) and 33% showed submucosal invasion (13/40). They were median 2.0 cm in size and more commonly located in the proximal stomach than ET-IGNs (70.6% vs. 41.9%,  p  < 0.001). EUT-IGN was independently related with age < 60 (OR, 2.09; 95%CI, 1.03–4.26,  p  = 0.042),  H. pylori  (OR, 2.81; 95%CI, 1.20–6.63,  p  = 0.018), and absent/mild gastric atrophy (OR, 2.67; 95%CI, 1.25–5.72,  p  = 0.011). Overall and disease-specific survival were not significantly different between the two groups, however EUT-IGN tended to have short disease-specific survival (overall survival,  p  = 0.143; disease-specific survival,  p  = 0.083).    Conclusions  Uniform screening endoscopy with two-year interval seems not enough for rapid-growing gastric neoplasms, such as undifferentiated cancers. They tended to develop in adults younger than 60 with  H. pylori  infection without severe gastric atrophy. More meticulous screening, especially for proximal lesions is warranted for adults younger than 60 with  H. pylori  infection before development of gastric atrophy.    Supplementary Information  The online version contains supplementary material available at 10.1186/s12885-021-07929-y.

Characteristics of interval gastric neoplasms detected within two years after negative screening endoscopy among Koreans