Abstract
A recently published American Gastroenterological Association (AGA) guideline supported endoscopic surveillance of gastric intestinal metaplasia (GIM) for patients at higher risk of gastric cancer (GC).1 However, the optimal surveillance endoscopic modality for GIM is yet solidified in the United States. Although the updated Sydney System, a comprehensive endoscopic biopsy protocol, has been advocated for GIM mapping,2 the challenges are the heterogeneous distribution of GIM, suboptimal diagnostic accuracy of high-definition white light (HDWL) endoscopy to detect GIM, and the cost burden and safety of multiple biopsies.
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