Endoscopic procedures for central carcinoid tumors carry several pitfalls. First, lymph node status is not determined. A small proportion of patients with typical carcinoid tumors will have occult lymph node metastasis, which can affect long-term prognosis. Second, there are risks of procedural bleeding, and we recommend that endoscopic management of carcinoids should be performed only by pulmonologists and surgeons skilled in the management of endoscopic bleeding complications. Finally, endoscopic management may require repeated procedures over a patient’s lifetime. The need for repeated procedures should be factored into the treatment plans, particularly in patients with a long life expectancy. We agree that additional investigation comparing endoscopic and surgical management of central carcinoid tumors is needed. Until additional data are available, however, we recommend that surgical treatment be the first-line therapy in patients with acceptable operative risk, and treatment should be performed by surgeons experienced with sleeve bronchial resections.