{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T10:29:58Z","timestamp":1776940198744,"version":"3.51.4"},"reference-count":447,"publisher":"Georg Thieme Verlag KG","issue":"05","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endoscopy"],"published-print":{"date-parts":[[2025,5]]},"abstract":"Main Recommendations<\/jats:title>At a population level, the European Society of Gastrointestinal Endoscopy (ESGE), the European Helicobacter and Microbiota Study Group (EHMSG), and the European Society of Pathology (ESP) suggest endoscopic screening for gastric cancer (and precancerous conditions) in high-risk regions (age-standardized rate [ASR] >\u200a20 per 100\u200a000 person-years) every 2 to 3 years or, if cost\u2013effectiveness has been proven, in intermediate risk regions (ASR 10\u201320 per 100\u200a000 person-years) every 5 years, but not in low-risk regions (ASR <\u200a10).<\/jats:p>ESGE\/EHMSG\/ESP recommend that irrespective of country of origin, individual gastric risk assessment and stratification of precancerous conditions is recommended for first-time gastroscopy. <\/jats:p>ESGE\/EHMSG\/ESP suggest that gastric cancer screening or surveillance in asymptomatic individuals over 80 should be discontinued or not started, and that patients\u2019 comorbidities should be considered when treatment of superficial lesions is planned.<\/jats:p>ESGE\/EHMSG\/ESP recommend that a high quality endoscopy including the use of virtual chromoendoscopy (VCE), after proper training, is performed for screening, diagnosis, and staging of precancerous conditions (atrophy and intestinal metaplasia) and lesions (dysplasia or cancer), as well as after endoscopic therapy. VCE should be used to guide the sampling site for biopsies in the case of suspected neoplastic lesions as well as to guide biopsies for diagnosis and staging of gastric precancerous conditions, with random biopsies to be taken in the absence of endoscopically suspected changes. When there is a suspected early gastric neoplastic lesion, it should be properly described (location, size, Paris classification, vascular and mucosal pattern), photodocumented, and two targeted biopsies taken.<\/jats:p>ESGE\/EHMSG\/ESP do not recommend routine performance of endoscopic ultrasonography (EUS), computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET)-CT prior to endoscopic resection unless there are signs of deep submucosal invasion or if the lesion is not considered suitable for endoscopic resection.<\/jats:p>ESGE\/EHMSG\/ESP recommend endoscopic submucosal dissection (ESD) for differentiated gastric lesions clinically staged as dysplastic (low grade and high grade) or as intramucosal carcinoma (of any size if not ulcerated or \u2264\u200a30\u200amm if ulcerated), with EMR being an alternative for Paris 0-IIa lesions of size \u2264\u200a10\u200amm with low likelihood of malignancy.<\/jats:p>ESGE\/EHMSG\/ESP suggest that a decision about ESD can be considered for malignant lesions clinically staged as having minimal submucosal invasion if differentiated and \u2264\u200a30 mm; or for malignant lesions clinically staged as intramucosal, undifferentiated and\u200a\u2264\u200a20 mm; and in both cases with no ulcerative findings.<\/jats:p>ESGE\/EHMSG\/ESP recommends patient management based on the following histological risk after endoscopic resection:<\/jats:p>\n Curative\/very low-risk resection (lymph node metastasis [LNM] risk <\u200a0.5\u200a%\u20131\u200a%): en bloc R0 resection; dysplastic\/pT1a, differentiated lesion, no lymphovascular invasion, independent of size if no ulceration and \u2264\u200a30\u200amm if ulcerated. No further staging procedure or treatment is recommended.<\/jats:p>Curative\/low-risk resection (LNM risk <\u200a3\u200a%): en bloc R0 resection; lesion with no lymphovascular invasion and: a) pT1b, invasion \u2264\u200a500\u200a\u00b5m, differentiated, size \u2264\u200a30\u200amm; or b) pT1a, undifferentiated, size \u2264\u200a20\u200amm and no ulceration. Staging should be completed, and further treatment is generally not necessary, but a multidisciplinary discussion is required.<\/jats:p>\n Local-risk resection (very low risk of LNM but increased risk of local persistence\/recurrence): Piecemeal resection or tumor-positive horizontal margin of a lesion otherwise meeting curative\/very low-risk criteria (or meeting low-risk criteria provided that there is no submucosal invasive tumor at the resection margin in the case of piecemeal resection or tumor-positive horizontal margin for pT1b lesions [invasion \u2264\u200a500 \u00b5m; well-differentiated; size \u2264\u200a30\u200amm, and VM0]). Endoscopic surveillance\/re-treatment is recommended rather than other additional treatment.<\/jats:p>\n High-risk resection (noncurative): Any lesion with any of the following: (a) a positive vertical margin (if carcinoma) or lymphovascular invasion or deep submucosal invasion (>\u200a500\u200a\u00b5m from the muscularis mucosae); (b) poorly differentiated lesions if ulceration or size >\u200a20\u200amm; (c) pT1b differentiated lesions with submucosal invasion \u2264\u200a500\u200a\u00b5m with size >\u200a30\u200amm; or (d) intramucosal ulcerative lesion with size >\u200a30\u200amm. Complete staging and strong consideration for additional treatments (surgery) in multidisciplinary discussion.<\/jats:p>ESGE\/EHMSG\/ESP suggest the use of validated endoscopic classifications of atrophy (e.\u200ag. Kimura\u2013Takemoto) or intestinal metaplasia (e.\u200ag. endoscopic grading of gastric intestinal metaplasia [EGGIM]) to endoscopically stage precancerous conditions and stratify the risk for gastric cancer.<\/jats:p>ESGE\/EHMSG\/ESP recommend that biopsies should be taken from at least two topographic sites (2 biopsies from the antrum\/incisura and 2 from the corpus, guided by VCE) in two separate, clearly labeled vials. Additional biopsy from the incisura is optional.<\/jats:p>ESGE\/EHMSG\/ESP recommend that patients with extensive endoscopic changes (Kimura C3\u200a+ or EGGIM 5\u200a+) or advanced histological stages of atrophic gastritis (severe atrophic changes or intestinal metaplasia, or changes in both antrum and corpus, operative link on gastritis assessment\/operative link on gastric intestinal metaplasia [OLGA\/OLGIM] III\/IV) should be followed up with high quality endoscopy every 3 years, irrespective of the individual\u2019s country of origin.<\/jats:p>ESGE\/EHMSG\/ESP recommend that no surveillance is proposed for patients with mild to moderate atrophy or intestinal metaplasia restricted to the antrum, in the absence of endoscopic signs of extensive lesions or other risk factors (family history, incomplete intestinal metaplasia, persistent H. pylori infection). This group constitutes most individuals found in clinical practice.<\/jats:p>ESGE\/EHMSG\/ESP recommend H. pylori eradication for patients with precancerous conditions and after endoscopic or surgical therapy.<\/jats:p>ESGE\/EHMSG\/ESP recommend that patients should be advised to stop smoking and low-dose daily aspirin use may be considered for the prevention of gastric cancer in selected individuals with high risk for cardiovascular events.<\/jats:p>","DOI":"10.1055\/a-2529-5025","type":"journal-article","created":{"date-parts":[[2025,3,21]],"date-time":"2025-03-21T00:33:53Z","timestamp":1742517233000},"page":"504-554","source":"Crossref","is-referenced-by-count":98,"title":["Management of epithelial precancerous conditions and early neoplasia of the stomach (MAPS III): European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter and Microbiota Study Group (EHMSG) and European Society of Pathology (ESP) Guideline update 2025"],"prefix":"10.1055","volume":"57","author":[{"given":"M\u00e1rio","family":"Dinis-Ribeiro","sequence":"additional","affiliation":[{"name":"Precancerous Lesions and Early Cancer Management Group, Research Center of IPO Porto (CI\u2010IPOP)\/CI\u2010IPOP@RISE (Health Research Group), Portuguese Institute of Oncology of Porto (IPO Porto)\/Porto Comprehensive Cancer Center (Porto.CCC), Porto, Portugal"},{"name":"Gastroenterology Department, Portuguese Institute of Oncology of Porto, Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2691-7522","authenticated-orcid":false,"given":"Diogo","family":"Lib\u00e2nio","sequence":"additional","affiliation":[{"name":"Precancerous Lesions and Early Cancer Management Group, Research Center of IPO Porto (CI\u2010IPOP)\/CI\u2010IPOP@RISE (Health Research Group), Portuguese Institute of Oncology of Porto (IPO Porto)\/Porto Comprehensive Cancer Center (Porto.CCC), Porto, Portugal"},{"name":"Gastroenterology Department, Portuguese Institute of Oncology of Porto, Porto, Portugal"}]},{"given":"Hugo","family":"Uchima","sequence":"additional","affiliation":[{"name":"Endoscopy Unit Gastroenterology Department Hospital Universitari Germans Trias i Pujol, Badalona, Spain"},{"name":"Endoscopy Unit, Teknon Medical Center, Barcelona, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9103-9757","authenticated-orcid":false,"given":"Manon C.W.","family":"Spaander","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands"}]},{"given":"Jan","family":"Bornschein","sequence":"additional","affiliation":[{"name":"Medical Research Council Translational Immune Discovery Unit (MRC TIDU), Weatherall Institute of Molecular Medicine (WIMM), Radcliffe Department of Medicine, University of Oxford, Oxford, UK"},{"name":"Translational Gastroenterology and Liver Unit, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK"}]},{"given":"Tamara","family":"Matysiak-Budnik","sequence":"additional","affiliation":[{"name":"Department of Hepato-Gastroenterology & Digestive Oncology, Institut des Maladies de l\u2019Appareil Digestif, Centre Hospitalier Universitaire de Nantes Nantes, France"},{"name":"INSERM, Center for Research in Transplantation and Translational Immunology, University of Nantes, Nantes, France"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2945-6007","authenticated-orcid":false,"given":"Georgios","family":"Tziatzios","sequence":"additional","affiliation":[{"name":"Agia Olga General Hospital of Nea Ionia Konstantopouleio, Athens, Greece"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0614-0576","authenticated-orcid":false,"given":"Jo\u00e3o","family":"Santos-Antunes","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, Centro Hospitalar S. Jo\u00e3o, Porto, Portugal"},{"name":"Faculty of Medicine, University of Porto, Portugal"},{"name":"University of Porto, Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Instituto de Investiga\u00e7\u00e3o e Inova\u00e7\u00e3o na Sa\u00fade (I3S), Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9787-8175","authenticated-orcid":false,"given":"Miguel","family":"Areia","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, Portuguese Oncology Institute of Coimbra (IPO Coimbra), Coimbra, Portugal"},{"name":"Precancerous Lesions and Early Cancer Management Group, Research Center of IPO Porto (CI\u2010IPOP)\/CI\u2010IPOP@RISE (Health Research Group), RISE@CI-IPO, (Health Research Network), Portuguese Institute of Oncology of Porto (IPO Porto), Porto, 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University of Beira Interior, Covilh\u00e3, Portugal"}]},{"given":"Ricardo","family":"Marcos-Pinto","sequence":"additional","affiliation":[{"name":"Precancerous Lesions and Early Cancer Management Group, Research Center of IPO Porto (CI\u2010IPOP)\/CI\u2010IPOP@RISE (Health Research Group), RISE@CI-IPO, (Health Research Network), Portuguese Institute of Oncology of Porto (IPO Porto), Porto, Portugal"},{"name":"Gastroenterology Department, Centro Hospitalar do Porto, Porto, Portugal"},{"name":"Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal"}]},{"given":"Leticia","family":"Moreira","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, ICMDM, Hospital Cl\u00ednic, Universitat de Barcelona, Barcelona, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas (CIBEREHD), Spain"}]},{"given":"Ana 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