We read the article by ten Kate et al.(1), from the Dutch HNPCC group regarding small bowel cancer (SBC) risk in HNPCC patients with great interest. The study confirms our data from 2005 (2) regarding the localization of tumors and the absence of identifiable risk factors for SBC in HNPCC patients (i.e. gender, mutation, family history, personal cancer history). The authors additionally calculated a life-time risk of 4.2% for SBC using Kaplan-Meier statistics. Ten Kate et al. recommend a non-invasive surveillance strategy. However, the authors argue that the life time risk for gastric cancer (GC) may influence a surveillance strategy for SBC regarding upper intestinal endoscopy.