Table 4.

AGA Recommendations for Management of Gastric Intestinal Metaplasia

Statement	Strength of recommendation	Quality of evidence
1. In patients with GIM, the AGA recommends testing for Hpylori, followed by eradication over no testing and eradication	Strong	Moderate
2. In patients with GIM, the AGA suggests against routine use of endoscopic surveillance	Conditional	Very Low
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.a
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, the AGA suggests against routine repeat short-interval endoscopy with biopsies for the purpose of risk stratification	Conditional	Very Low
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.

^aThere are insufficient data to guide optimal surveillance interval. Based on indirect evidence regarding cumulative gastric cancer incidence among patients with GIM, repeat upper endoscopy with careful mucosal visualization and gastric biopsies of the antrum and body and any concerning lesions may be considered in 3–5 years among patients with incidentally detected GIM, if shared decision-making favors surveillance.