The guideline recommends endoscopic ultrasound (EUS) as the primary tool for characterizing subepithelial lesions (SELs). It suggests tissue diagnosis for SELs with GIST features if they are >20mm or high-risk, recommends endoscopic resection for growing type 1 gastric NENs, and advises against surveillance for most benign SELs if the diagnosis is clear.

Some authors disclosed receiving lecture fees, honoraria, research support, and consulting fees from various medical device and pharmaceutical companies, such as Olympus, Erbe, Boston Scientific, Cook Medical, Medtronics, Abbvie, Novartis, Bayer, Deciphera, and Roche. While these are disclosed, they could represent a potential conflict of interest influencing recommendations related to specific procedures or devices.

This guideline provides valuable recommendations for managing subepithelial lesions and neuroendocrine neoplasms using endoscopy. Although based mainly on retrospective studies and expert opinion, it offers a structured approach to diagnosis, surveillance, and resection, addressing a clinically important area with limited high-quality evidence. The disclosed conflicts of interest are noted and considered in the rating.