‘Patients at higher risk for gastric adenocarcinoma, including GA and GIM, should undergo a full systematic endoscopy of the stomach with clear photo-documentation of gastric regions and pathology. We suggest a minimum examination time of 7 min.’ (evidence level: moderate quality; grade of recommendation: strong; level of agreement: 100%)

‘Patients with image-enhanced features of CAG should undergo biopsies for confirmation of endoscopic diagnosis; biopsies are directed at mucosal sites within Sydney protocol areas where enhanced imaging discloses GIM. Biopsy samples should be collected in separate containers and labelled as either ‘directed' or ‘random’ to corroborate endoscopic staging assessment.’ (evidence level: low quality; grade of recommendation: strong; level of agreement: 93%)

‘Endoscopic surveillance every 3 years should be offered to patients diagnosed with extensive CAG or GIM, defined as that affecting the antrum and body.’ (evidence level: low quality; grade of recommendation: strong; level of agreement: 100%).

‘We do not recommend surveillance in patients with GA or GIM limited just to the gastric antrum unless there are additional risk factors, such as a strong family history of gastric cancer or persistent H. pylori infection, then we suggest 3 yearly surveillance.’ (evidence level: low quality; grade of recommendation: strong; level of agreement: 93%)

‘High definition endoscopy with chromoendoscopy (CE) is better than high definition white-light endoscopy alone for the diagnosis of gastric precancerous conditions and early neoplastic lesions.’ (high quality evidence)

‘For adequate staging of gastric precancerous conditions, a first time diagnostic upper gastrointestinal endoscopy should include gastric biopsies both for Helicobacter pylori infection diagnosis and for identification of advanced stages of atrophic gastritis’. (moderate quality evidence, strong recommendation)

‘Biopsies of at least two topographic sites (from both the antrum and the corpus, at the lesser and greater curvature of each) should be taken and clearly labelled in two separate vials. Additional biopsies of visible neoplastic suspicious lesions should be taken.’ (moderate quality evidence, strong recommendation)

‘Systems for histopathological staging (eg, Operative Link on Gastritis Assessment (OLGA) and Operative Link on Gastric Intestinal Metaplasia (OLGIM) assessment) can be used to identify patients with advanced stages of gastritis. If these systems are used to stratify patients, additional biopsy of the incisura should be considered.’ (moderate quality evidence, weak recommendation)

‘In patients with IM at a single location but with a family history of gastric cancer, or with incomplete IM, or persistent H. pylori gastritis, endoscopic surveillance with CE and guided biopsies in 3 years’ time may be considered.’ (low quality evidence, weak recommendation)

‘Patients with advanced stages of atrophic gastritis (severe atrophic changes or intestinal metaplasia in both antrum and corpus, OLGA/OLGIM III/IV) should be followed up with a high-quality endoscopy every 3 years.’ (low quality evidence, strong recommendation)

‘Patients with advanced stages of atrophic gastritis and with a family history of gastric cancer may benefit from a more intensive follow-up (eg, every 1–2 years).’ (low quality evidence, weak recommendation)