Objective      To examine the safety and efficacy of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) and its precancerous lesions

and to compare effectiveness of ESD versus gastrectomy for treatment of EGC.       Methods      We performed a retrospective cohort study including 3 668 cases of EGC or dysplasia treated by ESD at 5 hospitals (Zhongshan Hospital

Fudan University; Southwest Hospital

Xinqiao Hospital and Daping Hospital

Third Military Medical University;

and Qilu Hospital

Shandong University) from 2006 to 2013. One hundred and twenty-four cases of EGC treated by gastrectomy were also included in this study. Clinical outcomes including pathology

postoperative complication

and hospital stay

as well as 3-year survival were compared.       Results      From 2006 to 2013

3 668 patients with dysplasia or EGC were treated by ESD. The overall en bloc resection rate was 100%

the complete resection rate 99.0% and the histologically complete resection rate 99.0%. The incidence of perforation and postoperative bleeding was 0.76 % and 1.74%

respectively. Local recurrence rate was 0.04% and the post-treatment 3-year survival was 99.8%. There were no death cases related to ESD. Patients with EGC treated by gastrectomy had longer operative time (

P

0.01)

median hospital stay (

P

0.01) and higher complication rate (

P

0.01). The 3-year survival rate was 99.8% for ESD and 98.4% for gastrectomy group (

P

0.05).       Conclusion      ESD can be considered an effective

safe and minimally invasive method to deal with EGC and its precancerous lesions

which has similar clinical outcomes with radical gastrectomy for treatment of EGC. Patients receiving ESD have better perioperative outcomes in terms of operative time

complication

and hospital stay.