4cm mesenchymal tumor in the lower esophagus may be a mesenchymal tumor of the gastrointestinal tract. 4cm mesenchymal tumor has a high rate of malignant transformation, which may cause symptoms such as dysphagia and abdominal pain, and it can be treated by medication, surgery and other methods. 1. Drug treatment: such as imatinib mesylate, sunitinib, regorafenib, etc. Imatinib mesylate is used as the first-line treatment for advanced, recurrent or unresectable esophageal mesenchymal tumors, sunitinib is used as the second-line treatment for esophageal mesenchymal tumors, and regorafenib is the treatment for patients who can not tolerate imatinib or sunitinib, and regorafenib can be considered, and patients with liver disease should be cautious. 2. Surgical treatment: it can be treated by endoscopic resection, that is, under the endoscope, the mucosa is completely peeled off from the submucosa, which is suitable for patients with tumor diameter less than 20mm. Therefore, patients with 4cm mesenchymal tumors in the lower esophagus are preferred to be surgically resected, and drug-assisted treatment can be performed after surgery.