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Background Patients with chronic liver disease and cirrhosis at risk of hepatocellular carcinoma (HCC) are living longer. Current guidelines provide no unified recommendations on when to stop HCC surveillance. We explored clinician practices and attitudes towards stopping HCC surveillance.Methods A 27-item web-based survey was administered between August and October 2025 and distributed via gastroenterology and hepatology society mailing lists and professional networks through study group contacts. Responses were analysed using chi-squared tests with adjustment for multiple comparisons.Results 504 clinicians from 23 countries across 6 continents completed the survey. Most were male (63%), gastroenterology/hepatology consultants (69%), working in metropolitan public hospitals (70%), and performed HCC surveillance using transabdominal ultrasound with alpha-fetoprotein (80%). Most respondents agreed that stopping HCC surveillance should be considered in older patients or those with limited life expectancy (81%), yet discussions with patients were infrequent (10% never; 34% rarely; 36% sometimes). Only 30% felt HCC guidelines provide useful recommendations on stopping surveillance. Major barriers included a lack of clear guidelines, fear of HCC development after stopping surveillance, and concern about giving patients mixed messages ( IDDF2026-ABS-0048 Figure 1. Barriers to initiating discussion about stopping HCC surveillance). Key patient factors influencing decisions were performance status, estimated life expectancy, comorbidities and ability to safely undergo HCC treatment (≥80% rated as important or very important) (IDDF2026-ABS-0048 Figure 2. Patient factors in the decision to stop HCC surveillance). Roughly half of respondents would not stop surveillance based on age alone in patients with cirrhosis (49%) or non-cirrhotic chronic hepatitis B (50%) if functional status was good (IDDF2026-ABS-0048 Figure 3. Age to stop HCC surveillance in a patient with good functional status). The most commonly nominated age to stop surveillance was 81–85 years (21%). Younger clinicians (<50 years and/or <5 years post-training) were more likely to prioritise age and nominate a specific cut-off. Respondents from Asia were more likely to continue surveillance in elderly patients or those with limited life expectancy (29% vs 16% strongly agree, p=0.002), whereas Western respondents were more likely to offer stopping surveillance (62% vs 26% strongly agree, p=0.002).Conclusions Clinicians recognise the appropriateness of stopping HCC surveillance in selected elderly patients, yet practice remains inconsistent and patient discussions are infrequent. Lack of guidance and fear of adverse consequences highlight a critical evidence gap to inform future guidelines.Abstract IDDF2026-ABS-0048 Figure 1Abstract IDDF2026-ABS-0048 Figure 2Abstract IDDF2026-ABS-0048 Figure 3