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Endoscopic surveillance is recommended for individuals who delay risk-reducing total gastrectomy, although detection of signet ring cell carcinoma (SRCC) remains challenging. No Australian cohort has reported real-world endoscopic performance with surgical correlation in this population. We performed a 15-year retrospective cohort study of adult\n                    <jats:italic>CDH1<\/jats:italic>\n                    carriers undergoing esophagogastroduodenoscopy (EGD) at a tertiary familial cancer centre (2008\u20132023). Patients presenting with symptomatic invasive gastric cancer at initial endoscopy were excluded. Most EGDs were conducted as preoperative assessments prior to risk-reducing total gastrectomy, with a minority undertaken as longitudinal surveillance. Endoscopic findings, biopsy performance, surgical pathology, and postoperative outcomes were analysed. Eighty-two\n                    <jats:italic>CDH1<\/jats:italic>\n                    carriers from 31 families underwent 136 EGDs (median 1 per patient). SRCC was detected endoscopically in 38 patients (46.3%), predominantly via random biopsies. Overall sensitivity for SRCC detection was 67.9%, with random biopsies outperforming targeted sampling. Most lesions were identified at the initial EGD. Sixty-nine patients (84.1%) proceeded to total gastrectomy; SRCC was confirmed in 56 (81.2%), with variable tumour burden (1\u201373 foci). Invasive disease beyond pT1a was uncommon (2.9%). Postoperative complications occurred in 43.5%, most frequently anastomotic strictures requiring dilatation; there were no procedure-related deaths. Although occult SRCC was common, invasive malignancy beyond pT1a was infrequent, suggesting that many intramucosal lesions may have a more indolent course than previously assumed. Detection of SRCC at endoscopy remains challenging; however, these findings support a more individualized, risk-adapted approach to\n                    <jats:italic>CDH1<\/jats:italic>\n                    management. Longer-term prospective data are required to better define SRCC progression risk and guide decisions regarding surveillance and risk-reducing surgery.\n                  <\/jats:p>","DOI":"10.1007\/s10689-026-00586-9","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T09:03:32Z","timestamp":1783328612000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Endoscopic detection of signet ring cell carcinoma in CDH1 carriers: a 15-year single-centre experience"],"prefix":"10.1007","volume":"25","author":[{"given":"Omar","family":"Salehi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"Tjandra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jadon","family":"Karp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Boussioutas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,6]]},"reference":[{"issue":"5","key":"586_CR1","doi-asserted-by":"publisher","first-page":"533","DOI":"10.1038\/ncb3136","volume":"17","author":"T Lecuit","year":"2015","unstructured":"Lecuit T, Yap AS (2015) E-cadherin junctions as active mechanical integrators in tissue dynamics. 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Ethics approval was obtained from the Peter MacCallum Cancer Centre Human Research Ethics Committee (QA\/97246\/PMCC).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}],"article-number":"73"}}