ObjectiveTo evaluate the safety and long term efficacy of endoscopic resection of gastric stromal tumors with a diameter of >2 4 cm. MethodsThe clinical data of 307 patients, who underwent endoscopic or surgical resection and pathologically confirmed to be gastric stromal tumors with a diameter ≤4 cm in Fujian Provincial Hospital, Jinshan Branch of Fujian Provincial Hospital or Fujian Geriatric Hospital from January 2014 to December 2019, were collected. The propensity score matching (1∶1) was performed for the cases with the tumor size of >2 4 cm.Then the incidence of adverse events related to the operation and clinical outcomes were compared between 41 patients in the endoscopic group and 41 patients in the surgical group. ResultsCompared with the surgical group, the median operation time in the endoscopic group was significantly shorter (580 min VS 1080 min, Z=-4789,P<0001), and the median hospitalization cost was significantly lower (227 thousand yuan VS 420 thousand yuan, Z=-7164, P<0001). There were no significant differences in postoperative fasting time or postoperative hospitalization time between the two groups (P>005). Complications occurred in 7 cases (171％) in the endoscopy group, including 5 cases of postoperative acute infection, 1 case of postoperative perforation, and 1 case of postoperative bleeding; all 9 cases (220％) in the surgical group developed postoperative acute infection. There was no significant difference in the overall incidence of complications between the two groups (χ2=0311, P=0577). Tumors in both groups were completely removed with negative resection margins. The follow up time of the endoscopy group was 343±156 months, and that of the surgical group was 422±202 months. No recurrence or distant metastasis was observed during the follow up period in the two groups. ConclusionEndoscopic resection of large gastric stromal tumor (range>2 4 cm) is safe and effective in the long term, which can be used as one of the methods for gastrointestinal stromal tumors.