Objective：This study aims to investigated and summarized the risk factors and clinicopathological characteristics of synchronous multiple early gastric cancer（SMEGC） to help clinicians improve the detection rate of SMEGC. Methods：Medical records of patients with early gastric cancer （EGC） or high-grade intraepithelial neoplasia （HGIN） wete retrospectively reviewed form June 2014 to December 2018. In total，517 patients were included. Results：SMEGC was diagnosed in 35 patients（6.8%）. Male （P=0.028），chronic atrophy gastritis（P=0.024），and moderate to severe intestinal metaplasia（P=0.048） were independent risk factors for the SMEGC. Also，there were no significant differences in survival rates between patients with SMEGC and patients with single neoplasm（P=0.976）. Further，main or minor lesions were defined according to Moertel standard. Main and minor lesions showed significant positive correlation in size（r=0.779，P=0.001）. Macroscopic types were identical in 51%（P=0.02）between main lesions and minor lesions. Conclusion：Therefore，the endoscopic physicians need a more meticulous endoscopic examination and find the possibility of SMEGC considering characteristics of main and minor lesions.