Gastric macula, also known as yellow pigment tumor, lipid island or gastric mucosal macula, is a yellowish-white tumor-like plaque formed in the gastric mucosa, which is a benign lesion. The cause of this lesion is not clear, but may be related to abnormal lipid metabolism and genetic factors. The lesion occurs in the middle-aged and elderly population and is associated with a history of diabetes mellitus. Gastric xanthomas are termed as a result of the accumulation of lipid-filled foam cells in the lesion tissue during excision of the lesion for pathologic examination. Although the lesion becomes benign, there is some tendency for it to become cancerous. Therefore, after diagnosis of the lesion, surgical treatment is mostly recommended, which can be accomplished by endoscopic maneuvers. The lesion is completely peeled off by endoscopic submucosal dissection. Pathological examination must be carried out after surgery to further analyze and confirm the diagnosis of the lesion. At the same time, it is important to pay attention to regular follow-up observation to monitor the development of the lesion. Some patients may have recurrent lesions, which can be detected and surgically stripped again.