Background and Aim: Progression of endoscopic diagnosis contributes improvement of detecting early gastric cancer (EGC). Endoscopic resection like endoscopic submucosal dissection (ESD) achieves surefire treatment of EGC. Now metachronous gastric cancer (MGC) after ESD becomes a problem. We analyzed the patients who had MGC after ESD to clarify the feature of MGC. Methods: We conducted retrospective analysis of EGC cases resected by ESD in our institution. From April 2014 through August 2019, 393 patients were performed ESD and 38 cases (9.7%) were MGC including 10 synchronous (within 1 year after ESD). We analyzed age, sex, interval of recurrence, location, macroscopic type, histological type, size of tumor, depth of invasion, history of eradication of Helicobacter Pylori (HP), detecting method and curative ratio by ESD. The study was approved by IRB. Result: The outcomes were as follows: MGC including synchronous was 9.7% (38/393) during this surveillance. Sex: male/female ratio was 35/3. Average age: 74.0AE4.7 years old (61-86, median 74). Average interval of recurrence: 45.7AE41.6 months (2-168, median 33.5). 68% (26/38) of cases experienced a recurrence within 5 years after previous ESD. The maximum recurrence was 3 times. Location: Upper 19, Middle 4, Lower 15. 76% (29/38) of cases arose from different location from the previous one. Macroscopic type: 0-IIa 12, 0-IIb 4, 0-IIc 22. 42% of cases were same type as previous one. Histological type: 37 tubular adenocarcinoma and 1 poorly differentiated adenocarcinoma. Average size: 11.4AE7.8 mm (1.5-37, median 10). Depth of invasion: M 36, SM 2. History of eradication of HP: 53% (20/38). In those cases, the longest interval of recurrence was 12 years and the shortest one was 2 years. Detecting method: white-light imaging 74%, indigo carmine dye 26%. Narrow-band imaging (NBI) or magnifying endoscopy with NBI was not used at the first detection of EGC. Curative ratio by ESD: 97% (37/38). Almost cases were less than 30mm tubular adenocarcinoma existed in mucosal layer, therefore, they were curative. Just one case (por, SM1) was not curative by ESD. Conclusion: In our analysis, MGC after ESD was 9.7%. The majority of cases were curative by ESD. 53% of cases had history of eradication of HP. They had severe atrophic gastritis and metaplasia. Even after eradication of HP, the patients performed ESD for EGC also still need continuous periodic endoscopic examination. To make sure effectivity of eradication of HP after ESD for EGC, additional prospective analysis is necessary.