Background: Treatment of myogenic neoplasms of the stomach consists of surgical resection, the extent of which is controversial given their variable malignant potential. Previous reports on the technique and results of a combined endoscopic/laparoscopic intragastric excision of these tumors showed excellent perioperative recovery and short-term outcomes. We present here our long-term outcomes of this minimally invasive approach.Methods: Using a prospective registry of gastric stromal tumor resections, we identified all patients who underwent surgery from 1999-2008. Data collected included patient demographics, presenting symptoms and diagnostic work-up, operative and perioperative course, and long term follow-up. Results: Sixteen gastric lesions were resected from 15 patients over a ten year period using combined endoscopic/laparoscopic intragastric excision. Mean age was 61.5 years (range 36-85) and seven patients were female. All patients underwent preoperative endoscopy for a variety of symptoms and signs including abdominal pain (n = 4), dyspepsia (n = 5), and anemia (n = 6). Endoscopic ultrasound (EUS) was performed on 11 patients (73.3%) to further evaluate tumor size and depth of involvement. Five lesions were located at the gastroesophageal junction, seven in the proximal body, two at the mid-body/greater curvature, and two at the incisura. Eleven tumors were biopsied endoscopically, all of which were negative for malignancy. A standard endolaparoscopic approach was performed on all patients. Complete submucosal enucleation was achieved on eight (50%) lesions while the remaining required transmural excision. There were no major operative or post-operative complications or deaths. Average length of stay was 4.3 days (range 1-11). Mean tumor size was 3.5 cm (range 1.5-7.0), and all were benign on final pathology. Follow-up studies included EGD, EUS, and capsule endoscopy. At a mean follow-up of 32 months (range 0.5-90), there have been no recurrences. Fourteen patients (93.3%) are alive to date, with one death secondary to cardiovascular causes.Conclusions: Initial reports describing the combined endoscopic/laparoscopic intragastric technique showed promising short-term outcomes. This study represents one the largest series of myogenic tumor excision using this combined technique. Our experience indicates that this is a safe and effective approach for small-to-moderate size tumors with excellent long-term oncologic results.