Intrathoracic gastric migration (ITGM) is a common complication following metabolic bariatric surgery, occurring after various procedures, with the highest reported incidence after sleeve gastrectomy. The pathogenesis of ITGM is multifactorial, including intraoperative anatomical disruption, postoperative weakening of gastric fixation structures, and thoracoabdominal pressure gradients. Patients may be asymptomatic or present with symptoms related to gastroesophageal reflux disease. Currently, there is no unified diagnostic criteria or standardized management strategy for ITGM. To improve the diagnosis and treatment of ITGM after metabolic bariatric surgery in China, the Chinese Society for Metabolic and Bariatric Surgery and Beijing Metabolic & Bariatric Doctor Association convened a panel of 117 experts nationwide to develop a consensus based on the latest evidence and clinical experience. The consensus addresses 16 key issues, including diagnostic methods, monitoring strategies, indications for surgical intervention, and specific management protocols for ITGM following different metabolic bariatric procedures. This consensus provides evidence-informed recommendations for the diagnosis and management of ITGM after metabolic bariatric surgery in China. Further high-quality prospective studies are needed to strengthen the evidence base and optimize future recommendations.