Objective To evaluate the efficacy of endoscopic and surgical treatment of gastric stromal tumors with a diameter of 2 ~ 5 cm，and to explore the clinical value of endoscopic resection of gastric stromal tumors of 2 ~ 5 cm in diameter. Methods A total of 225 cases of gastric stromal tumor with a diameter of 2 ~ 5 cm and confirmed by postoperative pathology in the First Affiliated Hospital of Zhengzhou University from July 2012 to January 2021 were collected. They were divided into endoscopic group（n = 104）and surgical group（n = 121）. The general data，operation time，postoperative hospital stay，postoperative fasting time，intraoperative and postop⁃ erative complications and long ⁃ term follow ⁃ up tumor recurrence were compared and analyzed between the two groups. Results There was no significant difference between the two groups in age，sex，tumor site，operation time，and complete resection rate（P > 0.05）. There were statistically significant differences in tumor diameter， tumor growth pattern，clinical manifestations，risk grading，and mitotic figures between the two groups（P < 0.05）. The postoperative hospital stay and postoperative fasting time in the endoscopic group were shorter than those in the surgical group，and the differences were statistically significant. The incidence of complications in the endoscopic group（6.7%）was lower than that in the surgical group（20.7%），showing statistical difference. With a median follow⁃up of 40 months，1 case of recurrence in the endoscopic group（the recurrence rate was 1.0%）and 2 in the surgical group（the recurrence rate was 1.7%）were found，and there was no significant difference in the recur⁃ rence rate between the two groups（P > 0.05）. Conclusion Endoscopic treatment of non⁃metastatic gastric stromal tumors with a diameter of 2⁃5cm is a safe and effective method. The prognosis of patients with endoscopic treatment is comparable to that with surgical treatment. It can be used as one of the main methods for the treatment of gastric stromal tumors.