Intestinal metaplasia (IM) is a common gastric lesion that is considered premalignant. Our study aims to determine the relationship between normal white light endoscopy and histopathological IM diagnoses. This retrospective study evaluated the endoscopic prevalence and histopathological confirmation rate in 229 suspected IM patients among 3247 patients who underwent elective esophagogastroduodenoscopy between October 2016 and May 2020. All endoscopic processes were performed by the same clinical endoscopist. We analyzed and reviewed demographic data, endoscopic findings, and endoscopic biopsy pathology results of all patients obtained from medical records. The endoscopic prevalence of IM was 7.02. IM diagnosis was pathologically confirmed in 92.1% of the patients who were diagnosed with endoscopy. IM was more common in male patients (57.2%) than in female patients. Of the IM patients, 59% were aged ≥ 50 years, whereas 5.2% were aged ≥ 20-30 years and 22.7% ≥ 60-70 years. The incidence of Helicobacter pylori (H.pylori) was 40.2%. The endoscopic diagnosis of gastric intestinal metaplasia, which is a precancerous lesion, was in great agreement with histopathological diagnosis. However, the prevalence of endoscopic IM diagnosis was below that of histopathological diagnosis. IM diagnosis can be made more accurately by diligent and detailed endoscopic examination, particularly in older male patients.