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Although most are benign, a substantial proportion represents gastrointestinal stromal tumors (GISTs), which carry malignant potential even at this small size. Histological confirmation is critical for appropriate risk assessment and treatment planning. However, the diagnostic yield of endoscopic ultrasound\u2010guided tissue acquisition (EUS\u2010TA) is limited for SELs &lt;\u200920\u2009mm due to technical challenges such as lesion mobility and short needle stroke. Mucosal incision\u2013assisted biopsy (MIAB), which enables direct visualization and targeted sampling, has emerged as a practical alternative. This narrative review summarizes current evidence on endoscopic diagnostic approaches for SELs &lt;\u200920\u2009mm, including both sampling methods (EUS\u2010TA, MIAB) and nonsampling techniques such as contrast\u2010enhanced EUS, elastography, and artificial intelligence (AI)\u2010assisted image analysis. Each modality has distinct advantages and limitations, and selection should be based on lesion characteristics, endoscopist experience, and resource availability. Nonsampling modalities offer complementary information and are expected to become increasingly relevant. A comprehensive understanding of available diagnostic techniques is essential to support accurate clinical decision\u2010making for SELs &lt;\u200920\u2009mm.<\/jats:p>","DOI":"10.1111\/den.70079","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T06:52:54Z","timestamp":1768200774000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Endoscopic Diagnosis of Gastric Subepithelial Lesions &lt;\u200920\u2009mm: Current Strategies and Emerging Solutions"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9567-9738","authenticated-orcid":false,"given":"Yosuke","family":"Minoda","sequence":"first","affiliation":[{"name":"Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences Kyushu University  Fukuoka Japan"},{"name":"Department of Endoscopic Diagnostics and Therapeutics Kyushu University Hospital  Fukuoka 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