Gastric lipomas are rare benign tumors, and acute bleeding from these lesions is exceptionally uncommon, usually occurring in large ulcerated antral lipomas. A 65-year-old high-risk patient presented with melena, syncope, and acute anemia. Endoscopy revealed a giant ulcerated subepithelial mass in the antrum, and EUS confirmed a well-defined hyperechoic submucosal lesion consistent with a lipoma. After stabilization, the patient underwent ESD. ESD enabled complete en bloc removal without complications, with rapid clinical recovery and stabilization of hemoglobin. Histology confirmed a large submucosal lipoma with ulceration. ESD is a safe and effective minimally invasive treatment for large or bleeding gastric lipomas, even in comorbid patients, offering a valid alternative to surgery.