Transanal endoscopic microsurgery (TEM) provides promising outcomes for rectal gastrointestinal stromal tumors (GISTs) while preserving function.

• High rates of R0 resection were achieved in 13 patients with rectal GIST, underscoring the technique’s efficacy.
• Tumor size should not automatically disqualify candidates for en-bloc excision with negative margins.

Neoadjuvant imatinib may help select borderline cases, but more extensive studies are needed to solidify patient criteria and outcomes.