1.Can gastric xanthoma lead to gastric cancer? Gastric xanthoma is a lipid deposition disease that occurs in the gastric mucosa. It used to be considered a rare, asymptomatic benign lesion of the stomach, named for its yellowish-white appearance. Its histopathology consists of lipid-filled foam cell aggregates. The etiology is currently unknown. It has been found that gastric xanthomas may be an alarm signal for early gastric cancer. Some Japanese scholars retrospectively analyzed the incidence of gastric xanthomas, gastric cancer, and their relationship with various clinicopathological features. The analysis showed that gastric cancer was independently associated with gastric xanthomas. In addition, gastric xanthinoma was significantly correlated with gastric cancer. Gastric xanthinoma was found in 50 out of 105 gastric cancer patients, thus inferring that gastric xanthinoma may be an alarm signal for early gastric cancer. It may predict the development of early gastric cancer. Some foreign researchers used endoscopic follow-up to investigate whether gastric xanthinoma could predict the development of early gastric cancer. In the initial endoscopic screening examination, 107 cases of gastric xanthomas were detected among 1823 patients. In the subsequent endoscopic follow-up, 29 patients with early gastric cancer were detected among 1823 patients. 15 of the 107 patients with gastric xanthomas developed gastric cancer. Multivariate analysis showed that gastric xanthoma was independently associated with the development of gastric cancer, thus it was hypothesized that gastric xanthoma could predict the development of gastric cancer. 2.Does gastric xanthoma need treatment? The natural course of gastric xanthoma is unknown. Some studies suggest that it can disappear on its own without any intervention, and most of them conclude that gastric xanthoma does not require treatment, but follow-up endoscopy is needed. Its presence is usually accompanied by a variety of pathologic states, such as chronic inflammation of the mucosa, HP infection, disorders of lipid metabolism, and chronic underlying diseases. Therefore, control of chronic inflammation, eradication of HP infection, elimination of lipid metabolism disorders, and aggressive treatment of underlying diseases may help gastric xanthoma to regress. It has also been reported that endoscopic resection is needed when gastric xanthoma is combined with inflammatory polyps or hyperplastic polyps. Based on recent studies on the association between gastric xanthomas and gastric cancer, there is a need to be vigilant about gastric xanthomas. Whether or not endoscopic treatment is performed, close endoscopic follow-up is required. The decision to treat or not to treat is based on the patient’s wishes and the size of the xanthoma lesion, as well as whether it is associated with atrophic gastritis or early gastric cancer. In the endoscopic treatment of gastric xanthoma, for smaller lesions, after complete removal of the biopsy forceps, attention should be paid to the trauma with or without active blood seepage, and metal clip suture or electrocoagulation should be given to stop bleeding if necessary. Yellows tumors that are higher than the mucosal plane and smaller in diameter can be excised by electrocoagulation with a trap. Flat and larger diameter xanthomas can be treated with endoscopic mucosal resection. The resection area should be larger than the lesion area, and try to maintain the integrity of the excised specimen for histopathologic examination. Endoscopic argon ion coagulation, laser coagulation, and radiofrequency ablation are available as treatment modalities, which are easy and fast to perform, but biopsy specimens cannot be obtained. Given that the etiology of gastric xanthoma is still unclear, patients with gastric xanthoma who have metabolic disorders such as blood glucose and dyslipidemia in combination with atrophic gastritis, especially those with multiple gastric xanthomas, need to be actively treated for metabolic abnormalities and atrophic gastritis in addition to the management of gastric xanthoma lesions.