AIM To gain knowledge of xanthelasma,a large populationbased study was conducted. METHODS Patients who underwent upper gastrointestinal endoscopy at the First Affiliated Hospital,College of Medicine,Zhejiang University,Hangzhou,China during Jan 2009 to Nov 2016 were included. General characteristics as well as clinical data were collected,including blood routine,serum biochemical analysis,endoscopic findinds,histological evaluation and comorbiditie. Statistical analyses was performed using SPSS 20.0 software for Windows(IBM Inc.,Chicago,IL,United States) using Student’s t-test,Mann-Whitney U test,χ2 test,univariable and multivariable logistic analysis. 2-tailed P value less than 0.05 was considered to be statistically significant. RESULTS A total of 176006 endoscopies were retrieved and we included 1370 xanthelasma participants(703 men,667 women) in this study. Prevalence of xanthelasma was 0.78% with average age of 56.6 ± 11.2 years. Chief complaint of xanthelasma consisted abdominal pain (24.2%),up-abdominal discomfort(14.1%),abdominal distention(10.1%),dyspepsia(9.1%),et al. Most xanthelasma occurred as single lesion in gastric antrum. Xanthelasma patients witnessed higher Helicobacter pylori(H. pylori) infection rate,more of other gastric lesions including atrophy,intestinal metaplasia and dysplasia(P < 0.01). In xanthelasma patients,serum carcinoembryonic antigen,triglyceride,fasting glucose,neutrophil,neutrophil-to-lymphocyte ratio were significantly higher,and high density lipoprotein-cholesterol,lymphocyte was lower(P < 0.05). Xanthelasma accompanied with more fatty liver disease and hepatic cyst,but fewer gallbladder polyp(P < 0.05). In logistic regression,it revealed that fasting plasma glucose(OR = 3.347,1.170-9.575,P < 0.05),neutrophil(OR = 1.617,1.003-2.605,P < 0.05),and carcinoembryonic antigen(OR = 2.011,1.236-3.271,P < 0.01) were all independent risk factors in xanthelasma. CONCLUSION Current study described a large xanthelasma cohort in Chinese population,revealed its relationship with H. pylori infection,carcinogenesis,metabolic dysfunction and inflammation as well. METHODS Patients who underwent upper gastrointestinal endoscopy at the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China during Jan 2009 to Nov 2016 were included. General characteristics as well Statistical analyzes were performed using SPSS 20.0 software for Windows (IBM Inc., Chicago, IL, United States) using Student’s t-test, RESULTS: A total of 176006 endoscopies were retrieved and we included 1370 xanthelasma participants (703 men, 667 women). The Mann-Whitney U test, χ2 test, univariable and multivariable logistic analysis. ) in this study. Prevalence of xanthelasma was 0.78% with average age of 56.6 ± 11.2 years. Chief complaint of xanthelasma consisted abdomina l pain (24.2%), up-abdominal discomfort (14.1%), abdominal distention (10.1%), dyspepsia (9.1%), et al. Most xanthelasma occurred as single lesion in gastric antrum. Xanthelasma patients witnessed higher Helicobacter pylori (P <0.01). In xanthelasma patients, serum carcinoembryonic antigen, triglyceride, fasting glucose, neutrophil, neutrophil-to-lymphocyte ratio were significantly higher, and In logistic regression, it revealed that fasting plasma glucose (OR = 3.347, P <0.05). In logistic regression, it revealed that fasting plasma glucose , 1.170-9.575, P <0.05), neutrophil (OR = 1.617,1.003-2.605, P <0.05), and carcinoembryonic antigen (OR = 2.011,1.236-3.271, P <0.01) were all independent risk factors in xanthelasma. CONCLUSION Current study described a large xanthelasma cohort in Chinese po pulation, revealed its relationship with H. pylori infection, carcinogenesis, metabolic dysfunction and inflammation as well.