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Background and aims: Gastric schwannoma (GS) is not well clinically recognized and surgical resection (SR) remains the mainstay of treatment. Recently, endoscopic resection (ER) appears to be a safe and effective alternative. However, its comparative outcomes with SR is lacking. Our aim was to first compare clinical outcomes and costs between ER and SR in the management of GSs. Methods: A total of 46 consecutive patients with GSs who underwent ER (n= 16) or SR (n= 30) in our large tertiary center between July 2007 and Oct 2018 were included. Clinicopathologic features, clinical outcomes, medical costs and follow-up were retrospectively reviewed and compared between two groups. Results: Baseline characteristics are comparable except for a smaller tumor size in ER group (22.9 vs 41.0 mm, p= 0.002). Complete resection was achieved in 87.5% of patients with ER and 100% of patients with SR (p= 0.116). The ER group had a significant shorter operative time (91.6 vs 128.2 min), less blood loss (16.9 vs 62.7 mL) and lower operation cost (21,054.4 vs 30,843.4 RMB) than SR group (all p< 0.05). There was no significant difference in adverse events (12.5% vs 10%, p= 0.812) and length of postoperative hospital stay (8.3 vs 8.2 days, p= 0.945). During a long-term follow-up of mean 37.4 months (range 6–140 months), no residue, recurrence or metastasis was observed in both groups. Conclusions: Compared with SR, ER has the similar safety and efficacy in the management of GSs, but contributes to a shorter operation time and lower medical costs. ER may be considered as the first-line treatment, especially for patients with GSs smaller than 30 mm.

Background and aims: Endoscopic resection (ER) is an effective and safe method for gastric submucosal tumors, mostly composed of gastrointestinal stromal tumors and leiomyomas. The role of ER in gastric schwannoma (GS) has rarely been described. Our aim was to evaluate the efficacy and safety of ER for GS. Methods: This is a retrospective study in consecutive patients who underwent ER for GS from March 2013 to October 2018 at our center. Clinicopathological, endoscopic, and follow-up data were collected and analyzed. Results: A total of 16 consecutive patients (9 females, 56.3%) were included, with a mean age of 50.4 years (range 25–75 years). The mean tumor size was 22.9 ± 15.1 mm (range 10–55 mm). Thirteen tumors (81.3%) were located in the middle third of the stomach and 12 tumors (75%) grew with intraluminal pattern. Endoscopic submucosal excavation (ESE) was performed in 7 patients while endoscopic full-thickness resection (EFTR) was done in 9 patients. R0 resection was achieved in 14 patients (87.5%). The mean operative time was 91.6 ± 52.8 min (range 36–203 min) and the mean postoperative length of hospital stays was 8.3 ± 2.7 days (range 6–13 days). No adverse events were encountered except for fevers in 2 patients. No patients required surgical resection or intervention. During long-term follow-up of mean 21.8 months (range 6–62 months), no residue, recurrence, or metastasis was observed. Conclusions: ER is effective and safe for patients with GS with favorable long-term outcomes.