What is the recommended surveillance approach for gastric intestinal metaplasia in patients without gastric cancer risk factors?

For U.S. patients with gastric intestinal metaplasia (GIM) without high-risk features, both the AGA and the ACG recommend testing for and eradication of Helicobacter pylori infection as the primary intervention for gastric cancer prevention, while routine surveillance endoscopy is not recommended in average-risk individuals.

In patients with high-risk features, including incomplete GIM, extensive antral and corpus involvement, first-degree family history of gastric cancer, or severe corpus extended atrophic gastritis, the ACG recommends surveillance endoscopy every 3 years, with interval adjustment based on individualized risk stratification.

References

1. Gupta et al., PMID 31816298
2. Morgan et al., PMID 40072510

The most recent AGA guidelines from 2019 do not provide clear guidance on endoscopic follow-up for patients with gastric intestinal metaplasia (GIM), detected either intentionally or incidentally, but rather provide an algorithm that factors in Helicobacter pylori (H. pylori) infection status, family history of gastric cancer, type/extent of GIM, and country of origin. To answer this question, I would consider gastric cancer risk factors as the following:

• family history of gastric cancer.
• extensive GIM (involving the gastric body/corpus).
• high-risk GIM pathology (incomplete GIM).
• immigrants from geographic regions with high incidence of H. pylori (basically every country except the United States, Canada, western Europe, and Oceania).

For patient...