Management of Gastric Precancerous Lesions and Early Cancer: Practice-Oriented Answers to Clinical Questions

Background/Objectives: Gastric precancerous conditions and early gastric cancer represent a heterogeneous disease spectrum with variable malignant potential and complex management pathways. Despite well-established international guidelines, discrepancies remain between recommended strategies and routine clinical practice, particularly regarding endoscopic diagnosis, risk stratification, therapeutic selection, and follow-up. This review aims to synthesize current evidence and provide practice-oriented, question-based guidance for the management of gastric precancerous lesions and early gastric cancer. Methods: A comprehensive review of the literature was conducted using PubMed and Google Scholar, focusing on endoscopic diagnosis, histological risk assessment, therapeutic options, and surveillance strategies for gastric precancerous lesions and early gastric cancer. Key areas of clinical uncertainty and controversy were identified and translated into focused, practice-oriented clinical questions designed to reflect and possibly help to improve real-world gastroenterological practice. Results: Clinical questions were formulated to cover the entire management pathway, from endoscopic detection and characterization to therapeutic decision-making and post-treatment surveillance. Topics include high-quality endoscopic diagnosis, biopsy strategies, histological staging system, selection between endoscopic and surgical therapy, and follow-up according to individual risk profile. For each question, current evidence is summarized into concise, actionable recommendations. Conclusions: Management of gastric precancerous lesions and early gastric cancer requires a structured and individualized approach, integrating high-quality endoscopy, accurate histological risk stratification, and evidence-based therapeutic and surveillance strategies. Organizing available evidence into practice-oriented clinical questions may help harmonize clinical practice, reduce unwarranted variability, and support gastroenterologists in delivering optimal patient-centered care.