Gastric Intestinal Metaplasia (GIM) Surveillance
Gastric Intestinal Metaplasia (GIM) is a pre-cancerous condition where the stomach lining begins to resemble that of the intestines. While GIM itself is not cancer, it is associated with a higher risk of developing stomach cancer. GIM surveillance is a structured monitoring programme that helps detect early changes before cancer develops. With regular and advanced screening, this risk can be managed effectively.
Dr. John Hsiang is a distinguished gastroenterologist in Singapore with extensive training and experience in digestive health. He obtained his Fellowship of the Royal Australasian College of Physicians in Gastroenterology in 2012 and holds a PhD in viral hepatitis and fatty liver disease research.
He provides care for a broad range of digestive and liver concerns, combining thorough evaluation with tailored management to support patients’ long-term well-being.
Dr Hsiang is skilled in performing gastroscopy (upper endoscopy) and colonoscopy to investigate symptoms, detect stomach and colon cancers at an early stage, and provide timely treatment options.
With a commitment to individualised care, he applies an evidence-based approach that prioritises accuracy, effectiveness and patient comfort at every stage of diagnosis and treatment.
Languages Spoken:
English, Mandarin and Hokkien
Fellowship Trained Specialist
20+ Years of Clinical Experience
What is Gastric Intestinal Metaplasia (GIM)?
GIM often arises from chronic inflammation, most commonly due to long-standing Helicobacter pylori (H. pylori) infection. Other contributing factors may include smoking, dietary habits, and genetic predisposition.
While the altered cells are more resistant to acid, they carry an increased risk of progressing to gastric cancer over time.
GIM usually does not cause specific symptoms and is often discovered incidentally during a gastroscopy performed for other concerns.
It is a relatively common finding; a local study showed that 7.2% of patients undergoing endoscopy in Singapore have intestinal metaplasia. This may be higher in other East Asia populations such as Chinese, Korean or Japanese.
Why is GIM Surveillance Necessary?
The primary goal of screening and surveillance is early detection. Regular monitoring of the stomach lining enables us to identify high-risk changes, such as dysplasia, or detect early-stage stomach cancer before symptoms appear.
This proactive approach allows for timely intervention, helping to prevent the progression to advanced cancer and significantly improving long-term outcomes.
Our Approach to GIM Screening & Surveillance
We take a thorough and patient-centred approach to GIM screening and surveillance, combining endoscopic evaluation with advanced non-invasive testing:
| Gastroscopy with Biopsy | GastroClear™ Blood Test (Advanced Risk Assessment) |
|---|---|
|
Gastroscopy, or upper endoscopy, is the most reliable method for detecting and monitoring GIM. During the procedure, the specialist carefully examines the stomach lining and takes multiple small tissue samples (biopsies) according to established clinical protocols. These are analysed by a pathologist to identify any dysplasia or signs of disease progression. |
As a complementary tool, we offer the GastroClear™ test—a blood test developed in Singapore and approved by the Health Sciences Authority (HSA). It measures specific microRNA biomarkers to assess the risk of stomach cancer. The results help guide decisions on the timing and need for gastroscopy. GastroClear™ is a convenient, non-invasive option for ongoing risk assessment between procedures, but does not replace gastroscopy when indicated for diagnosis. |
Who Should Consider GIM Screening and Surveillance?
Screening and surveillance are recommended for individuals diagnosed with Gastric Intestinal Metaplasia (GIM), especially those with additional risk factors that may increase the risk of stomach cancer:
- Family History – A first-degree relative diagnosed with stomach cancer.
- Ethnic Background – Individuals of East Asian descent may carry a higher baseline risk.
- Persistent H. pylori Infection – Particularly if the infection has not been successfully eradicated.
- Extensive Metaplasia – GIM involving a large portion of the stomach lining.
- Incomplete Metaplasia – A subtype of GIM associated with a higher risk of progression.
0.03-0.34%
(Stage 1 GIM)
Ongoing Monitoring
The surveillance interval and the risk of GIM progressing to stomach cancer are dependent on GIM stage criteria (OLGIM). The risk of stomach cancer progression per annum ranges from 0.03-0.34% per year for stage 1 GIM to 3-5% per year for stage 4 GIM.
Your GIM Screening and Surveillance Journey
Diagnosis and Risk Assessment
Ongoing Monitoring
If GIM is confirmed, ongoing surveillance may be recommended. This typically involves regular gastroscopies (e.g. every 1–3 years) to monitor for progression between procedures.
Review of Results
Timely Intervention
Patient Information
Does having GIM mean I will get stomach cancer?
No. While GIM is associated with a higher risk compared to the general population, most individuals with GIM do not develop stomach cancer. Surveillance is a preventive measure to monitor for early changes and manage this risk effectively.
Is Gastric Intestinal Metaplasia reversible?
The cellular changes in GIM are generally not considered reversible. However, addressing the underlying cause—such as eradicating H. pylori—can reduce inflammation and may help lower the risk of progression.
How should I prepare for a surveillance gastroscopy?
Preparation is the same as for any standard gastroscopy. You will need to fast for at least 6 to 8 hours before the procedure. Your doctor will provide specific instructions beforehand.
Does the GastroClear™ test require any preparation?
No special preparation is needed. The GastroClear™ test is a simple blood draw and does not require fasting.
Can lifestyle changes reduce my risk of progression?
Yes. Maintaining a healthy diet, avoiding smoking and alcohol, and addressing H. pylori infection can help reduce inflammation and support stomach health. These changes may also help lower the risk of GIM progressing to more advanced stages.
What happens if dysplasia is detected during surveillance?
If dysplasia (a pre-cancerous change) is found, your doctor may recommend closer monitoring or endoscopic treatment to remove the abnormal tissue. Early intervention significantly reduces the risk of developing stomach cancer.
Consult Our Specialist
Experiencing digestive symptoms or discomfort? Speak to our gastroenterologist for a clearer understanding of your condition and treatment options.
You may book an appointment using our contact form or call the clinic at 6517 9958
