Association between map-like redness and the risk of gastric cancer and high-risk precancerous lesions: a systematic review and meta-analysis

Background and aims: (HP) eradication has gained increasing attention. Map-like redness (MLR) is an easily recognizable and highly specific endoscopic feature observed after eradication. We aimed to quantify the association between MLR and the risk of GC and high-risk precancerous lesions. Methods: We conducted a systematic search in PubMed, Embase, the Cochrane Library, CNKI, Wanfang, CBM, and VIP databases up to April 23, 2025. The primary outcome was GC, and secondary outcomes were high-risk precancerous lesions defined as the Operative Link on Gastritis Assessment (OLGA) stage > II, Gastric Intestinal Metaplasia Assessment (OLGIM) stage > II, and Kimura-Takemoto (K-T) classification > C2. Results: eradication status yielded consistent results (ORs range: 3.77-5.55), and leave-one-out sensitivity analyses showed stable estimates (ORs range: 4.15-4.69), confirming the robustness of the findings. Conclusion: MLR is highly associated with an increased risk of GC and high-risk precancerous lesions. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420251048039, identifier CRD420251048039.