LAUSR

Figure 2. EUS view of 1-cm subepithelial lesion in the gastric antrum, arising from third layer of gastric wall. A 55-year-old man with no relevant medical history underwent EGD for the evaluation of dysphagia. A submucosal nodule was found in the gastric antrum, and he was referred to our center for further evaluation and treatment. EGD at our facility found a 1-cm subepithelial lesion in the gastric antrum (Fig. 1). The mucosa overlying the lesion appeared normal, with a "yellowish" hue; the remainder of the stomach and duodenum appeared normal. On EUS, a 7.11.5-mm isoechoic oval lesion was seen arising from the third layer of the gastric wall in the gastric antrum (Fig. 2). The lesion was thought to be too small for FNA; however, given that the lesion was isoechoic, tissue sampling was warranted to determine the etiology. No perigastric or subhepatic lymph nodes were seen. After EUS, the gastroscope was again advanced into the stomach. Using a "bite-on-bite" technique with a standard biopsy forceps, we systematically unroofed the underlying submucosal lesion with repeated forceps bites (Fig. 3). The bites were taken sequentially in the same spot, rather than randomly over the nodule, to properly expose the lesion. The appearance was consistent with a lipoma with glistening fat and a capsule. Using the biopsy forceps to grasp the lesion with avulsion, we peeled the lesion off the gastric wall (Fig. 4). Mild bleeding was controlled with 3 hemoclips (Fig. 5). Final histopathologic analysis confirmed a lipoma (Fig. 6).