International guidelines generally recommend regular follow-up rather than immediate biopsy or resection for asymptomatic SELs smaller than 2 cm. However, when GIST is confirmed histologically, complete removal is advised regardless of size [4,5]. In Korea, a standardized guideline for managing such lesions is lacking, resulting in significant variability among clinicians in diagnostic and therapeutic approaches.

In this context, Kim et al. [6] conducted a nationwide multicenter survey of Korean gastroenterologists from various levels of healthcare institutions to elucidate current practice patterns regarding the diagnosis and management of asymptomatic gastric SELs. Their findings revealed substantial variation in the clinical approach to asymptomatic gastric SELs, largely influenced by lesion size and institutional capacity. For lesions smaller than 1 cm, most physicians (70.4%) preferred regular endoscopic follow-up without performing biopsies, reflecting a conservative stance toward very small SELs. However, once lesions reached 2–3 cm, clinical behavior shifted—physicians at primary and secondary institutions often referred patients to higher-level centers, while those in tertiary hospitals were more likely to perform endoscopic ultrasound-guided biopsies (40.4%). Endoscopic resection was another key area of variation. It was predominantly performed in tertiary hospitals, with only 4.1% of lower-level institutions reporting its use, compared to 32.8% in tertiary care. Interestingly, 75.7% of all respondents felt that endoscopic resection is appropriate for SELs under 3 cm, suggesting a shared threshold for intervention.

This study is the first to provide a comprehensive national overview of current clinical practices for managing asymptomatic gastric SELs in Korea. By categorizing responses based on healthcare level, the study sheds light on how resource availability and institutional experience shape diagnostic and treatment decisions. Importantly, a majority of gastroenterologists agreed that 2–3 cm represents a key threshold at which more active intervention—including biopsy or resection—should be considered. At the same time, the study raises important questions that still need answers—such as whether all SELs in this size range should be removed, and how smaller lesions should be followed over time. To answer these questions and improve patient care, further studies are needed. The findings of this nationwide survey highlight the urgent need for standardized guidelines in the management of asymptomatic gastric SELs in Korea.

Importantly, the upcoming guideline on the diagnosis and endoscopic management of gastric subepithelial tumors, soon to be released by the Korean College of Helicobacter and Upper Gastrointestinal Research, is expected to address many of these unanswered questions. It is anticipated that this guideline will serve as a practical and reliable reference for gastroenterologists across Korea, supporting more consistent, evidence-based care.