I often encounter patients online and in clinic with endoscopy reports asking whether various endoscopically detected lesions require endoscopic or surgical procedures, which is a major concern for patients and a problem with some commonality. I will explain in my space one after another for some questions in plain language, hoping that patients can understand their condition in time and choose the appropriate treatment. Question 1: What should I do if I find a submucosal lesion in the digestive tract? The wall of the digestive tract can be roughly divided into mucosal layer, lamina propria, mucosal muscle layer, submucosal layer, and lamina propria. Submucosal lesions are lesions below the intrinsic layer of the esophagus, and most of them are found incidentally during endoscopy in asymptomatic cases. Some patients’ complaints of discomfort are also unrelated to the lesion found. The majority of submucosal lesions in the esophagus are smooth muscle tumors of mucosal origin, followed by smooth muscle tumors of intrinsic muscle origin and, less commonly, cysts, hemangiomas, lipomas, nerve sheath tumors, etc. Primary malignant submucosal lesions are very rare. There are more types of submucosal lesions in the stomach than in the esophagus, including smooth muscle tumors, mesenchymal tumors, ectopic pancreas, lipomas, cysts, hemangioblastomas, and deep cystic gastritis, among others. Submucosal lesions in the intestine are less diverse and include mainly lipomas, cysts, hemangiomas, mesenchymal tumors, and so on. Submucosal lesions of the digestive tract vary in size, mostly from a few millimeters to several centimeters, and rarely can exceed 5 cm or even reach more than 10 cm. The endoscopic appearance of benign submucosal lesions is a smooth elevation, and the origin of the lesion can be initially estimated based on the endoscopic appearance, but the diagnosis depends on ultrasound gastroscopy to clarify the layer of the canal wall. The intensity and homogeneity of the echogenicity will provide information to determine the nature of the lesion. If the decision is made to treat the lesion endoscopically, enhanced CT is also required for some lesions. Submucosal lesions can be removed endoscopically. Lesions originating above the submucosa can be resected by direct trap resection or submucosal dissection. Lesions located in the submucosal layer require submucosal dissection. Lesions originating from the intrinsic muscles of the esophagus cardia require submucosal tunneling for resection, and lesions originating from the intrinsic muscles of the stomach can be excavated in situ or excised from the entire gastric wall. Surgical treatment is considered first for lesions of intrinsic intestinal muscle origin, and endoscopic treatment is not generally recommended, although there have been successful attempts at endoscopic treatment for individual lesions. The need for resection for each lesion needs to be analyzed and evaluated from a variety of perspectives, taking into account the size and origin of the lesion, the initial diagnosis, the patient’s age and physical condition, and the patient’s state of mind once he or she understands the condition. There is no consensus opinion on the endoscopic treatment of submucosal lesions, and the basic tendency is to follow smaller lesions for which the diagnosis of benignity is certain, unless the patient strongly requests treatment. For smaller lesions with a low likelihood of malignancy, endoscopic treatment is not recommended in elderly patients. The indications for treatment of submucosal lesions in young and middle-aged patients can be relaxed, but follow-up observation is recommended for smaller lesions that do not have a predisposition to malignancy. Endoscopic treatment may be considered for those with a potential malignant tendency, without a benign diagnosis, and with strong patient demand for treatment, but the treatment of each submucosal lesion needs to be fully evaluated and weighed against the pros and cons. Surgical treatment is preferred for submucosal lesions considered to be malignant. Question 2: How to treat pancreatic dystocia pancreatic dystocia is a kind of poor passage or inability to pass food due to paradoxical contraction of the cardia sphincter. With the accelerated pace of life and increased mental stress, the incidence is on the rise. Although it is a benign disease, it seriously affects the quality of life and needs to be treated as soon as it is diagnosed. Traditional endoscopic treatment methods mainly include large balloon dilation and botulinum toxin injection. Most of the dilatation treatments are effective, but the effect depends on the diameter of the dilatation. If the diameter of the dilatation is too small, the effect of tearing the internal ring muscle will not be achieved, but the risk of perforation increases with the increase of the diameter of the dilatation. Injection therapy is safe and can provide symptomatic relief, but efficacy and maintenance time vary widely. In recent years, the development of transoral endoscopic endoesophageal myotomy (POEM) for the treatment of cardia loss has proven efficacy with a low recurrence rate and manageable complications. An increasing number of patients are receiving this treatment. A definitive diagnosis is needed to rule out other diseases causing dysphagia before undergoing POEM treatment. Tests include gastroscopy, barium meal angiography, esophageal manometry, and other tests necessary for the procedure. The procedure is performed under general anesthesia with tracheal intubation. Factors that affect the outcome are the length of the endocannabinoid dissection, whether the lower end exceeds the lower esophageal sphincter; the depth of the endocannabinoid dissection, and whether the full endocannabinoid dissection is achieved. In addition the postoperative outcome can vary between the different types of patients diagnosed by power testing. Complications mainly include subcutaneous emphysema, mediastinal emphysema and pneumothorax, but these complications are well managed after closing the mucosal incision. These complications are now rare in skilled surgeons. Rare complications include esophageal mediastinal fistula, intra-tunnel infection, postoperative bleeding, etc., but as long as the mucosal layer is properly protected, the tunnel entrance is reliably closed, and the intra-tunnel vascular coagulation is adequate, these complications are almost unlikely to occur. The advantages and disadvantages of comparing the three treatment methods are obvious, and patients should fully understand them before surgery and choose them with the help of doctors’ analysis. Question 3: What should be done when mucosal lesions suspected to be cancerous are found? China is a country with high incidence of digestive tract cancer. Compared with developed countries, the main problem is that there are fewer precancerous lesions and early cancers detected at early stage, and a higher proportion of cancers in the progressive stage. The cure of cancer is closely related to the early and late detection, the earlier the detection and the earlier the treatment, the better the effect, and the early detection and early treatment of cancer is completely curable. The detection of early cancer of digestive tract depends on endoscopy. Experienced doctors are needed to apply high definition endoscopy to detect more early mucosal lesions, and to evaluate the lesions with the help of staining and magnifying observation techniques, ultrasonic endoscopy techniques, and to determine the nature of lesions through precise biopsy. Different treatment methods are adopted for lesions of different nature, size and depth. Once a high-grade neoplastic lesion or well-differentiated intramucosal carcinoma of the GI mucosa is detected, try to consult a physician experienced in gastrointestinal endoscopic treatment to explore the possibility of minimally invasive endoscopic resection and not to undergo surgical treatment first under the psychological effect of cancer fear. Experienced endoscopists have good recognition of mucosal lesions and can not only detect lesions, but also identify them with high accuracy of biopsy. The fundamental difference between the two treatment methods is that EMR can only remove large lesions in pieces, with a relatively high rate of postoperative residual recurrence, and limited postoperative pathological diagnosis information. The ESD allows for complete resection of the diseased mucosa, obtaining an accurate postoperative pathological diagnosis and guiding us to the correct follow-up treatment. For mucosal lesions that are suitable for endoscopic treatment, preoperative evaluation will be done precisely by means of staining and magnification to increase the rate of curative resection while ensuring complete resection, which is the only way to truly benefit the patient. It is important to make clear that endoscopic mucosal resection is a therapeutic as well as a diagnostic method, and can be curative for lesions within the indications, and requires further surgery or complementary radiotherapy for lesions diagnosed postoperatively pathologically as being outside the indications.