In this retrospective study, Patrick Benusiglio and colleagues show that expert surveillance is safe in the hereditary diffuse gastric cancer syndrome. Among 20 CDH1 pathogenic variant carriers undergoing annual upper gastrointestinal endoscopy, none has developed aggressive signet ring cell carcinoma of the stomach, regardless of the presence of intramucosal (pT1a) cancer foci on biopsies. This work thus confirms the indolent nature of intramucosal lesions in this context. Their identification should not be seen as a formal indication for prophylactic total gastrectomy. (By Dr Patrick BENUSIGLIO, https://jmg.bmj.com/content/early/2025/11/20/jmg-2025-111222 )