AIM To systematically review the syndrome of giant gastric lipomas, report 2 new illustrative cases.METHODS Literature systematically reviewed using Pub Med for publications since 1980 with following medical subject heading/keywords:(“giant lipoma”) AND(“gastric”) OR [(“lipoma”) and(“gastric”) and(“bleeding”)]. Two authors independently reviewed literature, and decided by consensus which articles to incorporate. Computerized review of pathology/endoscopy records at William Beaumont Hospitals, Royal Oak and Troy, Michigan, January 2005-December 2015, revealed 2 giant gastric lipomas among 117110 consecutive esophagogastroduodenoscopies(EGDs), which were thoroughly reviewed, including re-review of original endoscopic photographs, radiologic images, and pathologic slides.RESULTS Giant gastric lipomas are extremely rare: 32 cases reported since 1980, and 2 diagnosed among 117110 consecutive EGDs. Average patient age = 54.5 ± 17.0 years old(males = 22, females = 10). Maximal lipoma dimension averaged 7.9 cm ± 4.1 cm. Ulcerated mass occurred in 21 patients. Lipoma locations: antrum-17, body-and-antrum-4, antrumintussuscepting-into-small-intestine-3, body-2, fundus-1, and unspecified-5. Intramural locations included submucosal-22, subserosal-2, and unspecified-8. Presentations included: acute upper gastrointestinal(UGI) bleeding-19, abdominal pain-5, nausea/vomiting-5, and asymptomatic-3. Symptoms among patients with UGI bleeding included: weakness/fatigue-6, abdominal pain-4, nausea/vomiting-4, early-satiety-3, dizziness-2, and other-1. Their hemoglobin on admission averaged 7.5 g/d L ± 2.8 g/d L. Patients with GI bleeding had significantly more frequently ulcers than other patients. EGD was extremely helpful diagnostically(n = 31 patients), based on characteristic endoscopic findings, including yellowish hue, well-demarcated margins, smooth overlying mucosa, and endoscopic cushion, tenting, or naked-fat signs. However, endoscopic mucosal biopsies were mostly non-diagnostic(11 of 12 non-diagnostic). Twenty(95%) of 21 abdominal CTs demonstrated characteristic findings of lipomas, including: well-circumscribed, submucosal, and homogeneous mass with attenuation of fat. Endoscopicultrasound showed characteristic findings in 4(80%) of 5 cases: hyperechoic, well-localized, mass in gastricwall-layer-3. Transabdominal ultrasound and UGI series were generally less helpful. All 32 patients underwent successful therapy without major complications or mortality, including: laparotomy and full-thickness gastric wall resection of tumor using various surgical reconstructions-26; laparotomy-and-enucleation-2; laparoscopic-transgastric-resection-2; endoscopicmucosal-resection-1, and other-1. Two new illustrative patients are reported who presented with severe UGI bleeding from giant, ulcerated, gastric lipomas.CONCLUSION This systematic review may help standardize the endoscopic and radiologic evaluation and therapy of patients with this syndrome. AIM To systematically review the syndrome of giant gastric lipomas, report 2 new illustrative cases. METHODS Literature systematically reviewed using Pub Med for publications since 1980 with the following medical subject heading / keywords: (“giant lipoma”) AND (“gastric Two authors independently reviewed literature, and decided by consensus which articles incorporate incorporate. ”Computerized review of pathology / endoscopy.“) OR [(”lipoma“) and (”gastric ") and records at William Beaumont Hospitals, Royal Oak and Troy, Michigan, January 2005-December 2015, revealed 2 giant gastric lipomas among 117110 consecutive esophagogastroduodenoscopies (EGDs), which were thoroughly reviewed, including re-review of original endoscopic photographs, radiologic images, and pathologic slides. RESULTS Giant gastric lipomas are extremely rare: 32 cases reported since 1980, and 2 diagnosed among 117110 consecutive EGDs. Average patient age = 54.5 ± 17.0 years old (males = 22, females = 10). Maximal lipo ma dimension averaged 7.9 cm ± 4.1 cm. Ulcerated mass occurred in 21 patients. Lipoma locations: antrum-17, body-and-antrum- 4, antrum intussuscepting-into-small- intestine- 3, body- 2, fundus- 1, and unspecified-5. Intramural locations included submucosal-22, subserosal-2, and unspecified-8. Presentations include: acute upper gastrointestinal (UGI) bleeding-19, abdominal pain- 5, nausea / vomiting-5, and asymptomatic-3. Among patients with UGI bleeding included: weakness / fatigue-6, abdominal pain-4, nausea / vomiting-4, early-satiety-3, dizziness-2, and other- 1. Their hemoglobin on admission averaged 7.5 g / dL ± 2.8 g / d L. Patients with GI bleeding had significantly more frequent ulcers than other patients. EGD was very helpful diagnostically (n = 31 patients), based on characteristic endoscopic findings, including yellowish hue, well-demarcated margins, smooth overlying mucosa, And endoscopic cushion, tenting, or naked-fat signs. However, endoscopic mucosal biopsies were mostly noTwenty (95%) of 21 abdominal CTs demonstrated characteristic findings of lipomas, including: well-circumscribed, submucosal, and homogeneous mass with attenuation of fat. Endoscopia showed characteristic findings in 4 ( All 32 patients underwent successful therapy without major complications or mortality, including: laparotomy and full-thickness gastric wall resection of tumor using various surgical reconstructions-26; laparotomy-and-enucleation-2; laparoscopic-transgastric-resection-2; endoscopic mucosal-resection- 1, and other- 1. Two new illustrative patients are reported who presented with severe UGI bleeding from giant, ulcerated, gastric lipomas. CONCLUSION This systematic review may help standardize the endoscopic and radiologic evaluation and therapy of patients with this syndrome.