1 Leung WK, et al. Gut 2025;0:1–20. doi:10.1136/gutjnl-2025-335823GuidelineAsian Pacif i c Association of Gastroenterology task force recommendations on surveillance for Helicobacter pylori associated gastric premalignant conditionsWai Keung Leung , 1 Tiing Leong Ang, 2 Shailja Shah , 3,4 Ka Shing Cheung , 1 Yunhao Li, 1 Noriya Uedo , 5 Wen- Qing Li , 6 Khay- Guan Yeoh , 7 Ratha- korn Vilaichone, 8 Thomas KL Lui, 1 Duc Trong Quach , 9 Lai Mun Wang, 2 Il Ju Choi , 10 Hidekazu Suzuki, 11 Hwoon- Yong Jung , 12 Hang Viet Dao, 13 Kaichun Wu, 14 Alex Boussioutas, 15,16 Mario Dinis- Ribeiro, 17 Yi- Chia Lee 18To cite: Leung WK, Ang TL, Shah S, et al. Gut Epub ahead of print: [please include Day Month Year]. doi:10.1136/gutjnl-2025-335823 ? Additional supplemental material is published online only. To view, please visit the journal online (https:// doi. org/ 10. 1136/ gutjnl- 2025- 335823).For numbered aff i liations see end of article.Correspondence toDr Wai Keung Leung; waikleung@ hku. hkReceived 8 May 2025Accepted 5 September 2025© Author(s) (or their employer(s)) 2025. Re- use permitted under CC BY- NC. No commercial re- use. See rights and permissions. Published by BMJ Group.ABSTRACTBackground The burden of gastric cancer remains substantial in Asia. Gastric premalignant conditions, including chronic atrophic gastritis, intestinal metaplasia and dysplasia, are important intermediate stages in the gastric carcinogenesis cascade. The sojourn time allows endoscopic surveillance to have a pivotal role in early detection and timely intervention.Objective This task force was commissioned by the Asian Pacif i c Association of Gastroenterology to formulate recommendations for the surveillance and management of Helicobacter pylori associated gastric premalignant conditions in the region.Design A systematic literature review was conducted across multiple databases, including PubMed, Cochrane Library and Embase, focusing on studies related to gastric premalignant conditions and their surveillance, particularly from Asia. The evidence quality and strength of recommendations were appraised using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.Results These recommendations address four key aspects of gastric premalignant condition surveillance: (1) epidemiology and risk factors; (2) endoscopic andhistopathological diagnosis; (3) risk stratif i cation andendoscopic surveillance strategies; and (4) managementstrategies. 28 statements were made after multiplerounds of voting by experts. The statements offer acomprehensive, evidence based framework designed toassist clinicians in the Asia Pacif i c region on the earlydetection and management of gastric premalignantconditions.Conclusion These statements aim to provide astructured, evidence based surveillance framework forclinical practice in the Asia Pacif i c region, while alsoidentifying priority areas for future research.INTRODUCTIONGastric cancer remains the fifth most common malignancy and the fourth leading cause of cancer related death worldwide. According to the latest GLOBOCAN 2022 data, 1 there were 968 784 new WHAT IS ALREADY KNOWN ON THIS TOPIC⇒ Asia accounts for 70% of the global gastriccancer burden, due to its massive populationand high prevalence of Helicobacter pyloriinfection.⇒ There are currently no regional guidelines orrecommendations for the Asia Pacif i c region onthe endoscopic surveillance and managementof these conditions.WHAT THIS STUDY ADDS⇒ 28 consensus statements addressed theepidemiology, endoscopic and histopathologicaldiagnosis, risk based surveillance interval andmanagement of gastric premalignant conditionsin Asia.⇒ For diagnosis, we emphasised the importanceof detailed and high quality endoscopicexamination and standardised gastric biopsyprotocols, together with proper pathologicalreporting for better risk stratif i cation.⇒ For most individuals with mild changes(operative link on gastritis assessment (OLGA)or operative link on gastric intestinal metaplasia(OLGIM) stage I) and in the absence of otherrisk factors, surveillance is not mandatory.⇒ In the highest risk patients (OLGA or OLGIMstages III–IV), biennial endoscopic surveillanceis suggested as a standard recommendation.HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY⇒ This consensus report helps to standardise theapproach to endoscopic diagnosis, surveillanceand management of gastric premalignantconditions in Asia, particularly in most Asiancountries without a nationwide gastric cancerscreening programme.⇒ The knowledge gap and priority area identif i edin this report will guide future research onsurveillance and prevention of gastric cancer inAsia, where gastric cancer is prevalent.
