Abort, Attack or Acknowledge?

This was noted on the greater gastric curve
WHAT DOES IT MEAN FOR YOUR MANAGMENT?

■ I'll take a biopsy

No harm in this!

■ I'll check the patients cholesterol levels

No more likely to be abnormal than avg!

■ I'll check the patients urate levels

Don't think that you can get tophi in the gut!

■ I'll look carefully for EGC's

Brilliant!

■ I'll remove it by EMR

You are wasting your time!

explanation

Of course this is a 'Gastric xanthelasma' which histologically consists of macrophages stuffed full of lipid. There isn't a strong link with abnormal serum lipids but there is a strong link with gastric atrophy and gastric intestinal metaplasia ... 

You will be familiar with 'Correa's hypothesis' and will know that widespread gastric atrophy and intestinal metaplasia is what's left when Helicobacters has run ravage for decades, leaving the stomach atrophied, achlorhydric and at risk of developing early gastric cancer!  

I used to regard gastric xanthelasma as a 'curiosity' only but actually, they are signposts that you should slow down and look VERY carefully for EGC's !!!