Gastric submucosal tumors are common lesions in gastroscopy, with mesenchymal tumors, smooth muscle tumors, and lipomas being the most common. Among them, mesenchymal tumors are potentially malignant and 1 cm is recommended for resection. The traditional method of resection is open or laparoscopic, but it is relatively more invasive. The endoscopic method of total gastric wall resection (EFR) belongs to the category of NOTES, which is a transnatural lumen surgery with less trauma, faster recovery and lower complication rate. The theoretical basis of EFR is that the mechanical barrier of the gastric wall consists mainly of the mucosal layer and the intrinsic muscular layer. If the tumor can be resected through gastroscopy while ensuring the integrity of the mucosal layer, it will enable the patient to avoid destruction of the abdominal wall and perigastric tissues. The treatment method is as follows: firstly, the gastroscope is inserted into the gastric cavity to determine the location of the lesion. The lesion is first marked with an incisional knife around the lesion and a submucosal injection of melanoma saline is made with a mucosal injection needle. The mucosa was incised along the edge of the lesion for 2/3 of a week with an incision knife, and then submucosal dissection was performed with an incision knife to turn over the surface mucosa. The intrinsic muscular layer was then incised with an incisional knife to expose the tumor and excise it, and the tumor was removed using a lithotomy basket. The incised mucosa is “sutured” with a hemostatic clip and nylon cord. Postoperative water fasting was performed for 1 week. Endoscopic total gastrectomy (EFR) also has its limitations. First, EFR is not suitable for tumors larger than 3 cm, and complications such as gastric bleeding, abdominal bleeding, peritonitis, abdominal abscess and pancreatitis may occur intraoperatively and postoperatively, most of which can be resolved after conservative or endoscopic treatment, but complications such as septic peritonitis and abdominal abscess require the assistance of general surgery.