Background Currently, surgical resection is recommended as the first choice for gastrointestinal stromal tumors (GISTs) larger than 2 cm. Endoscopic treatment may be considered for gastric GISTs smaller than 2 cm. However, for gastric GISTs with a diameter of 2-5 cm, there remains significant debate between surgeons and endoscopists regarding the safety and efficacy of endoscopic resection.

Objective To compare the efficacy and prognosis of endoscopic submucosal dissection (ESD) and laparoscopic surgery for patients with 2-5 cm gastric GISTs.

Methods  Clinical data about patients with gastrointestinal stromal tumors treated in the Department of Gastroenterology and General Surgery in the First Medical Center of Chinese PLA General Hospital from January 2017 to June 2022 were retrospectively collected. Patients were divided into endoscopic and laparoscopic groups based on surgical methods. The baseline data of the two groups were matched 1:1 using propensity score matching, and the outcome indicators of the two groups were compared to evaluate the perioperative indicators and prognosis of the two surgical methods.

Results A total of 145 patients were included in this study, with 47 cases in the endoscopy group and 98 cases in the laparoscopy group. After PSM, there were 41 patients in each group, with equal gender distribution: 19 males and 22 females. The average age was 52.7 ± 9.9 years in the endoscopy group and 54.5 ± 10.9 years in the laparoscopy group with no statistically significant difference (P＞0.05). Complete tumor resection was achieved in both groups, with no intraoperative tumor rupture or serious complications. The endoscopy group showed advantages in operation duration (MIQR: 71.550 - 90 min vs 85 60 - 120 min, P=0.011), intraoperative blood loss (MIQR: 42 - 5 mL vs 2010 - 50 mL, P=0.011) and hospitalization cost (MIQR: 3.52.8 - 4.0 ten thousand yuan vs 4.33.5 - 5.7 ten thousand yuan, P=0.006) compared to the laparoscopy group. However, the endoscopy group had a longer time to resume diet (MIQR: 43 - 5 d vs 33 - 5 d, P=0.038), with statistically significant differences. After 35(range: 12 - 70) months follow-up, all the patients in the two groups after PSM survived, with no recurrence.

Conclusion Endoscopic treatment of 2 - 5 cm gastric GISTs is comparable to surgical treatment in terms of safety and efficacy, with advantages such as shorter surgical duration, less bleeding, relatively lower hospitalization costs, preservation of the original anatomical structure of the stomach, and minimal functional damage.