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Background/Aims: Endoscopic submucosal dissection (ESD) has been widely accepted as a method of treatment of early gastrictumor. This study aimed to identify the incidence and characteristics of multiple gastric tumors after ESD. Methods: Patients with early gastric tumors who were treated by ESD from January 2004 to June 2012 and followed up withendoscopic examination periodically for at least 1 year were enrolled. All multiple gastric lesions were subsequently treated with ESDand the medical records of the patients were retrospectively reviewed. Results: In total, 643 patients were included. The mean duration of endoscopic follow-up was 45.27±27.59 (range, 12–148) months. Overall, 144 patients (22.4%) showed multiple gastric tumors during the follow-up period (44 synchronous [6.8%] and 100 metachronous[15.5%]). The cumulative incidence rate steadily increased during the follow-up period. More than 50% of the tumors that developed atthe same longitudinal location of the stomach were of the same macroscopic and histological type as the primary lesions. Conclusions: Because synchronous and/or metachronous gastric tumors are common, considerable attention should be paid to detectmultiple gastric lesions after ESD of early gastric neoplasm.

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