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The differential diagnosis of large gastric folds is diverse, and endoscopic biopsies are often too small to permit adequate morphologic evaluation. This article describes the morphology of large gastric folds obtained by electrosurgical endoscopic snare biopsy in a series of 52 patients. The great majority of patients with enlarged rugae presented with peptic ulcer symptoms. This series included 16 patients with hyperplastic gastropathies, 15 with chronic nonspecific gastritis, seven with gastric polyposis, three with adenocarcinoma, five with benign lymphoid hyperplasia, and the remainder with miscellaneous conditions. In all cases, the snare biopsy provided a full thickness mucosal biopsy adequate to fully evaluate the enlarged rugae.
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