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Background: There are emerging data to suggest that asymptomatic gastrointestinal stromal tumors (GIST) of the stomach are not uncommon. We sought to determine the incidence of these tumors in patients undergoing resection for epithelial tumors of the foregut as well as the impact on surgical and adjuvant treatment. Methods: A prospectively entered database chronicling all patients undergoing resection of non-GIST malignancies of the stomach and esophagus at a single university center over a 4-year period was accessed, and pathology reports were reviewed for the presence of synchronous GISTs. Patient demographics, tumor characteristics, operative procedures, and post-operative outcomes were reviewed for patients in whom a synchronous GIST was identified. Data presented as median (range).Results: From July 2005 to November 2009, 186 patients underwent gastrectomy (N=62) or esophagectomy (N=124) for a non-GIST malignancy (142 adenocarcinoma, 29 squamous cell carcinoma, 7 other). Of these, synchronous GISTs were identified in 4.3% (8/186), pre-operatively (N=1), intra-operatively (N=4), and upon final pathology (N=3). Median age of patients was 70 years (30-84) and most were male (6/8). Operative therapy was altered in 4 of 5 patients identified pre- or intra-operatively. In these patients, a wedge resection of the stomach was performed in the eventual gastric conduit following esophagectomy. Final pathology revealed completely resected tumors of 0.65 cm (0.2 - 5 cm) with low or very low malignant potential. None of the patients received adjuvant therapy for the GIST in addition to that for the epithelial tumour. At last follow up (16 (5-25) months), 3 patients have died from disease (epithelial cancer), 2 are alive with disease (epithelial cancer), and 3 are alive without disease. In no patient has GIST recurred.Conclusion: Synchronous GIST is not an uncommon incidental finding during resection of foregut malignancies that may alter surgical treatment but is unlikely to impact long term survival.