LAUSR

I read the article by Kumar and Gray with keen interest. I have a few comments to make regarding the article, which will help us, and the field in general, to better understand the gastric lipoma. The authors stated pre-resection diagnosis is difficult due to submucosal location. I would like to state that most gastrointestinal lipomas demonstrate characteristic endoscopic finding, which helps in pre-resection diagnosis. Characteristic endoscopic findings in case of gastric lipoma include a smooth subepithelial bulge with a yellow hue, pillow sign, tent sign and naked fat sign. Bite-on-bite forceps biopsy reveals lipocyte (naked fat sign). A naked fat sign is pathognomic of gastrointestinal lipoma. Pre-resection diagnosis can also be made with endoscopic ultrasonography (EUS). EUS examination reveals pathognomonic hyperechoic lesion with homogeneous pattern and well-defined borders arising from the submucosa. Because of high accuracy of EUS, the biopsy is not needed. Kumar and Gray also mentioned that standard of care for gastric lipoma is surgical resection. I would like to point out that a case series of 28 patients with gastrointestinal lipoma (15 large and 13 less than 2 cm in diameter) reported successful endoscopic resection without serious complications such as perforation or postprocedure stricture with a mean follow-up period of 19 month. One more large series including 15 patients with large lipoma >2 cm also reported successful snare resection without perforation or bleeding with at least 1 year follow-up. In my humble opinion, giant gastrointestinal lipomas can be removed safely by endoscopy when resection is necessary.