In the MAPS I Guideline, we recomme

In the MAPS I Guideline, we recommended that “Patientswith endoscopically visible high grade dysplasia or carcinomashould undergo staging and adequate management.” However,several studies have shown that low grade dysplasia (LGD) alsohas a real potential for malignancy and, even more importantly,visible lesions with LGD on biopsy may in fact already be malignant lesions. Moreover, some biopsies may be negative for dysplasia in the face of a true neoplastic lesion [27]. In a Westernendoscopic submucosal dissection (ESD) series, there was a histological upstaging after resection for 33 % of the lesions [28].Similarly, an Eastern study that analyzed 1850 lesions, focusingon the discrepancy between endoscopy biopsies and endoscopic resection specimens, concluded that the overall discrepancy rate was 32 % [27]. A meta-analysis that specifically investigated the upstaging of gastric LGD after endoscopicresection found that this happens in 25 % of lesions, with 7 %being upstaged to malignant [29]. Taking all this evidencetogether, we can conclude that endoscopic biopsies are insufficient for correct diagnosis of visible gastric lesions and that anendoscopically visible lesion with any neoplastic change shouldbe considered for treatment.