We read with interest the article by Yoshida etal.1 on successful en bloc resection of a large gastric lipoma by endo-scopic submucosal dissection (ESD) without complications. Although the authors concluded that ESD could become the standard treatment with minimal invasiveness for large gastric lipomas, we recommend the unroofing technique instead of ESD in this patient.Most gastrointestinal lipomas remain asymptomatic, but large lipomas can cause symptoms such as abdominal pain, bleeding, obstruction, and intussusception,2'3 necessitating removal.24 Endoscopic removal of large lipomas caries the increased risk of bleeding or perforation with technical difficulties.2'3 For safe endoscopic removal of large lipomas, various endoscopic techniques have been used with the assistance of endoscopic ultrasonography, clip, endoloop, and/or injection of the base.
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