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

Background and Aims Gastric intestinal metaplasia (IM) and dysplasia are precursor lesions for gastric cancer (GC). This systematic review and meta-analysis examined the global prevalence and progression rates of subtypes of these understudied lesions. Methods We searched databases for publications reporting prevalence and progression of subtypes of IM and dysplasia among individuals undergoing endoscopy, including incomplete/complete IM, limited (antrum-restricted)/extensive (corpus-involving) IM, and low-grade dysplasia (LGD)/high-grade dysplasia (HGD). Random-effects models were used to estimate pooled prevalence and progression rates to GC. I 2 statistic was used to determine heterogeneity. Results 83 studies were included for prevalence and 23 for progression. The prevalence of complete IM was 11% (95% confidence interval (CI) 8–15%) and incomplete IM was 10% (6–14%), with corresponding progression rates of 1.73 (1.08–2.79) vs. 12.15 (5.28–27.94) per 1000 person-years, respectively (p <0.01). The prevalence of limited vs. extensive IM was 12% (8–17%) vs. 5% (4–8%), respectively, and corresponding progression rates were 3.31 (1.18–9.32) vs. 4.19 (0.95–18.41) per 1000 person-years (p=0.80). The prevalence of LGD was 2% (1–4%) and HGD was 0.28% (0.14–0.55%), with corresponding progression rates of 11.55 (5.93–22.47) vs. 344.48 (144.88–819.09, p <0.01). Substantial heterogeneity was observed for all estimates. Conclusion While 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. While 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.