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Background: Gastric cancer (GC) is the fifth most common malignancy worldwide. Early detection of precancerous conditions - atrophic gastritis (AG), intestinal metaplasia (IM), and dysplasia - is vital for surveillance. Objectives: To assess the accuracy of single high-quality endoscopy (HQE) in detecting advanced GPCs and to identify risk factors for AG, IM, and dysplasia. Methods: A retrospective review of 442 gastroscopies (2017–2022) at a single center. Endoscopic findings were compared with histology, including OLGA/OLGIM staging, dysplasia, and Helicobacter pylori (HP) status. Results: The study population comprised 319 women (72.17%) and 123 men (27.83%), with a mean age of 59 years (SD: 12.53). AG, as defined by OLGA and OLGIM staging, was identified in 90 patients (20.36%) and 50 patients (11.31%), respectively. A total of 44 cases of de novo gastric dysplasia were observed, while HP infection was confirmed in 37 individuals (8.37%). We proved similar low sensitivity for detection of advanced OLGA (32,5%), OLGIM (40%) and dysplasia (19.7%) with relatively high specificity (~89%). Advanced AG and IM peaked at ages 51–53. Risk factors for advanced OLGIM included male sex (OR 2.26; P < 0.001) and presence of dysplasia (OR 2.09; P = 0.02). Dysplasia was positively associated with AG (OR 2.03; P < 0.001) and IM (OR 2.21; P < 0.001), but inversely associated with a family history of GC (OR 0.44; P < 0.001). Conclusions: A single HQE can help exclude advanced GPCs, but due to low sensitivity, gastric mapping biopsies remain crucial. Males are at increased risk of extensive IM. Family history of GC was linked to lower OLGA/OLGIM stages.