Table 1.

Summary of current guidelines addressing UGI cancer surveillance in Lynch syndrome.

Guideline	Year	Recommend Surveillance	Age to Initiate	Interval	Helicobacter pylori (Test and Treat)	Biopsy Recommendation	Quality of Evidence/Strength of Recommendation
European Society for Medical Oncology (ESMO) [16]	2013	Yes, for gastric cancer; Not for duodenal cancer	-	1–3 years, only in cases of individuals from “high incidence” populations	Yes	-	Not given
US Multi-Society Task Force [17]	2014	Yes	30–35	2–3 years “based on risk factors”	Yes	Gastric antrum	Expert consensus; GRADE rating: low
American College of Gastroenterology (ACG) [18]	2015	Yes	30–35	3–5 years, may be considered if there is a family history of gastric or duodenal cancer	Yes	Yes	Conditional recommendation, Very low quality of evidence
American Society of Clinical Oncology (ASCO) [15]	2015	Yes, for gastric cancer; Not for duodenal cancer	-	1–3 years in “in high incidence populations”	Yes	-	Not given
European Society of Digestive Oncology (ESDO) [19]	2018	Yes	No later than age 30	1–2 years	Yes	-	Not given
German Consortium for Familial Intestinal Cancer [20]	2019	Yes; for gastric and duodenal cancers	25	1–3 years	Yes	-	Not given
British Society of Gastroenterology (BSG) [14]	2020	No, only in context of clinical trial	-	-	Yes		Strong recommendation; GRADE rating: low
National Comprehensive Cancer Network (NCCN) [7]	2021	Consider	40	3–5 years in “high risk persons”: male, older age, MLH1 or MSH2 pathogenic variant, first degree relative with gastric cancer, Asian ethnicity, residing or immigrating from countries with high incidence of gastric cancer, chronic autoimmune gastritis, gastric intestinal metaplasia, gastric adenomas	Consider	Random biopsy of the proximal and distal stomach in high-risk persons	Category 2A: based upon lower-level evidence, there is uniform NCCN consensus that the intervention is appropriate
European Hereditary Tumour Group (EHTG) and European Society of Coloproctology (ESCP) [21]	2021	No	-	-	-	-	-