Differentiated-type (intestinal-type) gastric adenocarcinoma arises from a multistep process staring with Helicobacter pylori infection followed by gastric atrophy, gastric intestinal metaplasia. Patients with gastric precancerous conditions (GPC) are at high risk to develop gastric cancer even in regions with low incidence. Thus, the identification and surveillance of a high-risk subgroup could lead to the diagnosis of cancer at early stage and improve survival. However, both endoscopic and histological are still far from optimal. In this lecture, I describe the subject regarding risk stratification for developing early gastric cancer before and after the endoscopic examination.