Work

Prevalence and Progression of Subtypes of Gastric Premalignant Lesions: A Systematic Review and Meta-Analysis

Year: 2026

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: BACKGROUND & AIMS: Gastric intestinal metaplasia (IM) and dysplasia are precursor lesions for gastric cancer. This systematic review and meta-analysis examined the global prevalence and progression rates of subtypes of these understudied lesions. METHODS: statistic was used to determine heterogeneity. RESULTS: Eighty-three studies were included for prevalence and 23 for progression. The prevalence of complete IM was 11% (95% confidence interval [CI], 8%-15%) and of incomplete IM was 10% (95% CI, 6%-14%), with corresponding progression rates of 1.73 (95% CI, 1.08-2.79) vs 12.15 (95% CI, 5.28-27.94) per 1000 person-years, respectively (P < .01). The prevalence of limited vs extensive IM was 12% (95% CI, 8%-17%) vs 5% (95% CI, 4%-8%), respectively, and the corresponding progression rates were 3.31 (95% CI, 1.18-9.32) vs 4.19 (95% CI, 0.95-18.41) per 1000 person-years (P = .80). The prevalence of LGD was 2% (95% CI, 1%-4%) and of HGD was 0.28% (95% CI, 0.14%-0.55%), with corresponding progression rates of 11.55 (95% CI, 5.93-22.47) vs 344.48 (95% CI, 144.88-819.09; P < .01). Substantial heterogeneity was observed for all estimates. CONCLUSIONS: Although lesion subtypes with high progression risk like incomplete IM account for a large portion of the total burden of precancerous lesions, subtyping remains underutilized in clinical practice. Although estimates are limited by heterogeneity, differences in progression rates between lesion subtypes support risk stratification of these lesions within management guidelines, particularly complete vs incomplete IM and LGD vs HGD.

Source: Clinical Gastroenterology and Hepatology

DOI: 10.1016/j.cgh.2026.08.020