Abstract： Objective To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) for the removal of small gastrointestinal stromal tumor (GIST). Methods GIST diagnosed by endoscopic uhrasonography (EUS) was managed by ESD with the needle knife as follows: (1)Injecting normal saline into the submucosa. (2)Pre-cutting the surrounding mucosa of the lesion. (3) Dissecting the submucosal tissue to display GIST and resecting the lesion completely. Results Of 20 GISTs, 12 located in gastric fundus, and 1 in gastric antrum, 3 in gastric body and 4 in rectum. Lesion diameter ranged from 0.5 to 3.2 cm and the mean resected size was 1.6 cm. Among 20 lesions, 19 were resected with ESD completely, and 1 received additional operation because of tumor residual in the wound after ESD. The successf rate of ESD was 95.0% (19/20). The mean ESD procedure time was 87.5 rain (ranging from 60 to 150 rain). None of the patients had delayed bleeding after ESD.Perforations occurred in 3 cases after the dissection of the GIST, which were closed with metallic endoclips without additional surgical suture. The perforation rate of ESD was 15.0% (3/20). The follow up ranged from 2 to 12 months, and no recurrence was observed by EUS except the abovementioned case undergone additional operation. Conclusion ESD is effective and safe for small GIST,which can resect the whole lesion and provide pathological information.