Gastric cancer (GC) is the 5th leading cause of cancer-related mortality worldwide. Endoscopic surveillance of gastric intestinal metaplasia (GIM) may lead to earlier GC detection. Recent guidelines from the American Gastroenterological Association (AGA) emphasize Helicobacter pylori treatment and surveillance after GIM diagnosis. Adherence to GIM guidelines among U.S. gastroenterologists is unknown. Our aim was to examine variation in management of GIM and acceptance of a standardized GIM protocol among gastroenterologists at a U.S.