1. In patients with gastric intestinal metaplasia (GIM), AGA recommends testing for H. pylori, followed by eradication over no testing and eradication.
2. In patients with GIM, AGA suggests against routine use of endoscopic surveillance.
Comments: Patients with GIM at higher risk for gastric cancer who put a high value on potential but uncertain reduction in gastric cancer mortality, and who put a low value on potential risks of surveillance endoscopies, may reasonably elect for surveillance. Patients with GIM specifically at higher risk of gastric cancer include those with:
• Incomplete vs. complete GIM
• Extensive vs. limited GIM
• Family history of gastric cancer
Patients at overall increased risk for gastric cancer include:
• Racial/ethnic minorities
• Immigrants from high incidence regions
3. In patients with GIM, AGA suggests against routine repeat short-interval endoscopy with biopsies for the purpose of risk stratification.
Comments: Based on shared decision-making, patients with GIM and high-risk stigmata, concerns about completeness of baseline endoscopy, and/or who are at overall increased risk for gastric cancer (racial/ethnic minorities, immigrants from regions with high gastric cancer incidence, or individuals with family history of first-degree relative with gastric cancer) may reasonably elect for repeat endoscopy within 1 year for risk stratification.
