Objective During the last decade, the management of gastric intestinal metaplasia (GIM) has been addressed by several distinct international evidence-based guidelines. In this review, we aimed to synthesise these guidelines and provide clinicians with a global perspective of the current recommendations for managing patients with GIM, as well as highlight evidence gaps that need to be addressed with future research. Design We conducted a systematic review of the literature for guidelines and consensus statements published between January 2010 and February 2023 that address the diagnosis and management of GIM. Results From 426 manuscripts identified, 16 guidelines were assessed. There was consistency across guidelines regarding the purpose of endoscopic surveillance of GIM, which is to identify prevalent neoplastic lesions and stage gastric preneoplastic conditions. The guidelines also agreed that only patients with high-risk GIM phenotypes (eg, corpus-extended GIM, OLGIM stages III/IV, incomplete GIM subtype), persistent refractory Helicobacter pylori infection or first-degree family history of gastric cancer should undergo regular-interval endoscopic surveillance. In contrast, low-risk phenotypes, which comprise most patients with GIM, do not require surveillance. Not all guidelines are aligned on histological staging systems. If surveillance is indicated, most guidelines recommend a 3-year interval, but there is some variability. All guidelines recommend H. pylori eradication as the only non-endoscopic intervention for gastric cancer prevention, while some offer additional recommendations regarding lifestyle modifications. While most guidelines allude to the importance of high-quality endoscopy for endoscopic surveillance, few detail important metrics apart from stating that a systematic gastric biopsy protocol should be followed. Notably, most guidelines comment on the role of endoscopy for gastric cancer screening and detection of gastric precancerous conditions, but with high heterogeneity, limited guidance regarding implementation, and lack of robust evidence. Conclusion Despite heterogeneous populations and practices, international guidelines are generally aligned on the importance of GIM as a precancerous condition and the need for a risk-stratified approach to endoscopic surveillance, as well as H. pylori eradication when present. There is room for harmonisation of guidelines regarding (1) which populations merit index endoscopic screening for gastric cancer and GIM detection/staging; (2) objective metrics for high-quality endoscopy; (3) consensus on the need for histological staging and (4) non-endoscopic interventions for gastric cancer prevention apart from H. pylori eradication alone. Robust studies, ideally in the form of randomised trials, are needed to bridge the ample evidence gaps that exist. Data are available on reasonable request. All data analysed are available in proper databases depending on publisher.

中文翻译：

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通往世界统一的胃肠上皮化生患者管理方法之路：当前指南综述


目的 在过去十年中，胃肠上皮化生 （GIM） 的管理已由几个不同的国际循证指南解决。在本综述中，我们旨在综合这些指南，并为临床医生提供当前管理 GIM 患者建议的全球视角，并强调未来研究需要解决的证据空白。设计 我们对 2010 年 1 月至 2023 年 2 月期间发布的涉及 GIM 诊断和管理的指南和共识声明的文献进行了系统评价。结果 从确定的 426 篇手稿中，评估了 16 条指南。关于 GIM 内窥镜监测的目的，GIM 的指导方针是一致的，即识别普遍的肿瘤病变和胃癌前病变的分期。指南还同意，只有具有高危 GIM 表型 （例如，体扩展 GIM、OLGIM III/IV 期、不完全 GIM 亚型）、持续难治性幽门螺杆菌感染或一级胃癌家族史的患者才应接受定期间隔内窥镜监测。相比之下，低风险表型（包括大多数 GIM 患者）不需要监测。并非所有指南都与组织学分期系统保持一致。如果需要进行监测，大多数指南建议间隔 3 年，但存在一些差异。所有指南都建议根除幽门螺杆菌作为预防胃癌的唯一非内窥镜干预措施，而一些指南则提供了有关生活方式改变的额外建议。 虽然大多数指南都提到了高质量内镜检查对内镜监测的重要性，但除了说明应遵循系统的胃活检方案外，很少有指南详细说明重要指标。值得注意的是，大多数指南评论了内窥镜检查在胃癌筛查和胃癌前病变检测中的作用，但异质性高，实施指导有限，缺乏强有力的证据。结论 尽管人群和实践存在异质性，但国际指南普遍一致认为 GIM 作为癌前病变的重要性以及需要采用风险分层方法进行内窥镜监测，以及根除幽门螺杆菌（如果存在）。关于以下方面，指南有协调的空间 （1） 哪些人群值得接受胃癌指数内窥镜筛查和 GIM 检测/分期;（2） 高质量内窥镜检查的客观指标;（3） 关于组织学分期需求的共识和 （4） 除单独根除幽门螺杆菌外，非内窥镜干预预防胃癌。需要强有力的研究，最好是以随机试验的形式，来弥合存在的大量证据空白。数据可应合理要求提供。分析的所有数据都可以在适当的数据库中获得，具体取决于出版商。