Abstract:

In 2022, there were approximately 970 000 new cases and 660 000 deaths from gastric cancer worldwide, with East Asia (such as China, Japan, and South Korea) being the main high-incidence regions. Although the incidence rate and mortality rate of gastric cancer in China showed a slow decline from 2010 to 2020, the disease burden remains heavy due to the large population and insufficient early screening coverage. In 2025, the American College of Gastroenterology (ACG) released the American College of Gastroenterology Clinical Guidelines: Diagnosis and Management of Gastric Precancerous Lesions. The core content of the guidelines includes: ① individualized risk assessment: high-risk populations should be screened based on factors such as age, Helicobacter pylori (Hp) infection, and family history. ② High-quality endoscopic technical standards: the guidelines recommend using high-definition white-light endoscopy with image-enhanced technologies (such as narrow band imaging, NBI) to improve lesion detection rates and emphasize the standardization of biopsy pathology. It also recommends using the operative link for gastritis assessment (OLGA) and operative link for gastric intestinal metaplasia assessment (OLGIM) staging systems for gastric cancer risk stratification and surveillance, while emphasizing the core position of Hp eradication. ③ Endoscopic monitoring and follow-up intervals: the guidelines have important implications for the prevention and treatment of gastric cancer in China, including optimizing screening strategies, such as implementing precision screening for high-risk populations based on China's conditions and exploring combined screening models for colorectal and gastric cancer. It is essential to continue to improve the capabilities of endoscopic diagnosis and treatment, strengthen the training of grassroots physicians, advance high-quality endoscopic techniques (such as NBI magnifying endoscopy), strengthen Hp infection prevention and control, and implement synchronous screening and treatment for household clusters of infection. The surveillance system should be improved by referencing OLGA/OLGIM stratification to establish personalized monitoring intervals. Concurrently, evidence gaps must be addressed by conducting prospective studies to validate the rationality of surveillance intervals and developing non-invasive biomar-kers. Although some recommendations in the ACG guidelines are supported by limited evidence, the standardized framework provides important reference for early detection and treatment of gastric cancer in China. This approach helps address current challenges such as low screening coverage and high proportion of advanced-stage cases, ultimately reducing the di-sease burden.

Key words: Gastric cancer, Gastric precancerous lesions, Endoscopy, Guidelines