Endoscopic surveillance: time for a paradigm shift in hereditary diffuse-type gastric cancer management?

Individuals with a genetic predisposition to develop hereditary diffuse-type gastric cancer are advised to undergo a prophylactic total gastrectomy in early adulthood.1 Because the intervention has a large effect on the quality of life, whether to go ahead with the procedure should be a well considered decision. Epidemiological data suggest that 60–75% of patients with a pathogenic CDH1 variant will probably not develop life-threatening, metastatic, diffuse-type gastric cancer.2,3 The data, published in The Lancet Oncology, by Colin Y C Lee and colleagues4 and Bilal Asif and colleagues5 are valuable in understanding the role and safety of endoscopic surveillance as an alternative strategy to postpone or even avoid gastrectomy.