Gastric precancerous conditions
Treatment options in Shanghai

When a report says low-grade or high-grade dysplasia, or uses an uncertain phrase such as 'indefinite for dysplasia', expert gastrointestinal pathology review can be important. The next question is whether a visible lesion explains the finding. A high-quality repeat examination may be needed when dysplasia has no clearly identified lesion, while a visible abnormality requires assessment of its extent and appropriate management. Do not assume that a routine annual check is the right response to every dysplasia report. Obtain the slides or tissue blocks if the reviewing centre requests them.

Helicobacter pylori infection is a recognised risk factor, and management of infection is part of care for gastric precancerous conditions. Bring previous test results, eradication treatment details and any confirmation testing, rather than assuming that an old prescription proves the infection has cleared. A first-degree relative with stomach cancer and the pattern of the tissue changes can influence the discussion. Treating infection does not replace assessment of dysplasia or a suspicious visible lesion. The clinician should decide how testing and treatment fit into the overall plan.

The 2025 MAPS III guideline distinguishes extensive or advanced changes from limited changes without additional risk factors. Some patients need endoscopic surveillance; others may not need a routine surveillance programme on the basis of that finding alone. This is a risk-based framework, not an instruction that every person should undergo yearly gastroscopy. It is also a European guideline rather than a booking rule for China. Ask the treating specialist to explain the proposed interval, what features justify it and what new information would bring a review forward.