During gastroscopy, we often find bulging changes in the stomach wall, which is neither an intraluminal growth nor a bulging gastric cancer with an intact and smooth mucosa, and even if a surface biopsy is performed, no diagnosis can be made. There is a protruding piece like a wall, what is it? The first possibility, normal or abnormal conditions outside the stomach wall compress the stomach wall, such as liver indentation, spleen indentation, gallbladder indentation, which can be a normal organ, or an enlarged organ, or a tumor occurring within the organ. In the second possibility, a tumor has occurred within the stomach wall, which we usually refer to as a submucosal tumor, including smooth muscle tumor, mesenchymal tumor, lipoma, ectopic pancreas, and carcinoid tumor. How to identify the cause of the augmentation: How to distinguish whether it is an extraluminal pressure mark or a submucosal tumor? Ultrasound gastroscopy can help us make a diagnosis. Not only that, ultrasound gastroscopy can also help to clarify the origin site, scope, depth of infiltration of the lesion, relationship with neighboring organs, preliminary characterization of the augmented lesion by the nature of the echo, and provide a basis for further clinical management. How to deal with submucosal gastric tumors: Among the submucosal gastric tumors, lipomas, ectopic pancreas and cysts are benign changes, and if the diagnosis can be determined by ultrasound gastroscopy, they usually do not require treatment and can be observed by regular follow-up. Smooth muscle tumors or mesenchymal tumors can be differentiated by ultrasound gastroscopy. In the stomach, more than 85% are mesenchymal tumors and less than 15% are smooth muscle tumors. Mesenchymal tumors have potentially malignant behavior, and whether and how to manage them is still controversial. Management of mesenchymal tumors includes; regular follow-up; endoscopic treatment, including nylon cord ligation and endoscopic tumor debridement; and surgical treatment including endoscopic combined with laparoscopic resection and open surgical resection. The choice needs to be made on a case-by-case basis for each patient, in consultation with a specialist. Very small mesenchymal tumors, such as less than 1 cm, are usually asymptomatic and do not have ulcerated bleeding on the surface, and regular (e.g. 6-12 months) follow-up can be considered on the surface; endoscopic treatment, such as endoscopic nylon cord ligation treatment or endoscopic tumor debridement, can also be chosen. Moderate size mesenchymal tumors, such as 1~2 cm, may be asymptomatic or may have bleeding tumor surface ulceration. Aggressive management is generally advocated. Based on the results of ultrasound gastroscopy, endoscopic treatment is preferred for tumors originating from the mucosal muscle layer; endoscopic treatment can be chosen for tumors originating from the intrinsic muscle layer but protruding significantly into the gastric lumen; endoscopic combined with laparoscopic treatment is preferred for tumors growing outside the gastric lumen, and surgical treatment can be chosen for those with bleeding surface ulcers. or partial gastrectomy. Some patients present with recurrence after resection and need to receive drug therapy. Endoscopic treatment of gastric submucosal tumor: Endoscopic treatment of gastric submucosal tumor has the advantages of less trauma, lower cost and faster recovery. Endoscopic nylon rope ligation: It is used for the treatment of benign submucosal tumors, which is easy to operate and less traumatic. It is generally used for cases with small lesions. Ligation treatment has no pathological diagnosis and is not used for the treatment of malignant lesions such as early gastric cancer. Endoscopic tumor debridement: similar to the mucosal debridement method for early gastric cancer, the technique is more demanding and can completely debride the lesion and obtain pathological histological examination results. However, there is a risk of bleeding or perforation, which should be evaluated by an endoscopic specialist before surgery. Small bleeding can usually be managed gastroscopically, and small perforations can be closed endoscopically with metal clips. If there are exceptional cases, surgical management is required.