Cold snaring biopsies to increase screening efficacy during endoscopic surveillance of patients at high risk of diffuse gastric cancer

Diffuse gastric cancer (DGC) is a poorly differentiated adenocarcinoma of the stomach characterized by independent "signet-ring" cells that invade the gastric wall with mainly submucosal infiltration resulting in delayed diagnosis [1]. Mutations in the CDH1 gene, encoding E-cadherin, have been identified in families with multiple cases of gastric cancer, with a 50%–80% increased risk of DGC in carriers [2]. In cases with a proven constitutional CDH1 mutation, guidelines recommend prophylactic total gastrectomy between the ages of 20 and 30 years, or endoscopic surveillance if surgery is refused or postponed [3].