Intestinal metaplasia (IM), a precancerous precursor lesion to gastric cancer, can be subtyped as complete or incomplete, with the latter associated with a higher cancer risk. This article provides an in-depth evaluation of gross/endoscopic and microscopic findings and the role of special stains in distinguishing complete from incomplete IM. The authors also examine controversies surrounding IM subtyping, its impact on risk stratification, and its role in guiding surveillance. The article addresses the potential significance of IM subtyping in cancer progression and present arguments for its de-emphasis in clinical practice.