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This study aimed to investigate the risk factors for perforation during endoscopic snare resection with an elastic band (ESR-EB) resection of gastric submucosal tumors ≤ 10 mm, providing clinical guidance for preventing intraoperative adverse events. A retrospective study was conducted on patients who underwent ESR-EB resection of gastric submucosal tumors ≤ 10 mm at Shenzhen Second People's Hospital from April 2023 to October 2024. Clinical characteristics, tumor location, size, pathological type, resection time, operation time, and perforation rate were analyzed using binary regression analysis to identify risk factors for perforation. A total of 108 patients underwent ESR-EB surgery, with a mean age of 55.83 ± 9.27 years and 30.56% being male. The mean tumor size was 6.07 ± 1.42 mm, with intraluminal growth being the most common (88.89%). Tumors were primarily located in the fundus (72.22%) and body (27.78%) of the stomach. The mean operation and resection times were 21.22 ± 10.37 minutes and 9.02 ± 4.99 minutes, respectively. Gastrointestinal stromal tumors (GISTs) were the most common pathological type (75.93%), followed by leiomyomas (21.30%). Perforation occurred in 73.15% of cases during surgery, all of which were successfully closed endoscopically. Binary regression analysis showed that tumor location and histological type were risk factors for perforation. Tumors in the fundus increased perforation risk (odds ratio = 5.080, 95% confidence interval 1.234-20.923; P = .024). The risk of perforation was significantly reduced in non-GIST pathological types (odds ratio = 0.129,95% confidence interval 0.029-0.565; P = .007). Gender, age, tumor size, growth pattern, operation time, and resection time were not associated with perforation. ESR-EB can completely resect gastric submucosal tumors ≤ 10 mm. Perforation risk is higher when tumors are located in the fundus or are GISTs. Tumor location is a useful preoperative predictor of intraoperative perforation.