Large gastric folds

Large gastric folds are seen in a great number of benign and malignant conditions. Diagnosis represents a clinical challenge because etiology may be extremely varied and standard biopsies are often inconclusive. Gastric wall is considered thickened at endosonography when superior to 3.6 mm in width. Different diseases show different levels of infiltration of the gastric wall. When abnormalities involve layer 2 alone, benign conditions can be considered and endoscopic biopsies are often diagnostic. When abnormalities involve layers 2 and 3, different diseases can be suspected, including H. pylori infection and lymphoma; in this case large particle biopsy should be considered. When abnormalities involve layer 4, malignancy should be strongly suspected even if standard biopsies are negative Endosonography, used always in combination with biopsy, allows to rule out malignancies and to select the most appropriate treatment for each patient (medical or surgical).