Objective：This study aims to compare the difference of clinicopathological characteristics of endoscopic submucosal dissection（ESD） and surgery of early gastric cancer（EGC） patients，and to explore the difference of the absolute and expanded criteria for ESD，so as to provide a basis for choosing the best treatment for EGC. Methods：The clinicopathological data of 495 EGC lesions in the First Affiliated Hospital of Nanjing Medical University were prospectively observed，of which 163 patients treated with ESD，and 332 patients treated with surgery. Univariate and multivariate analyses were performed on 153 patients（observation group）in the ESD group and 183 patients（control group）in the surgical group who met the endoscopic resection criteria. Finally，the lymph node metastasis of surgical group was analyzed separately. Results：①Multivariate analysis showed that endoscopic forceps biopsy with carcinoma，flat type，ulcer，and submucosal invasion were influence factors for the selection of surgery（OR=25.970，3.970，7.244，5.038，P < 0.05）. ② In the ESD group，the overall accuracy of indication selection was 93.87%（153/163）. The pathology of 10 lesions met the surgical criteria were undifferentiated. ③Multivariate analysis showed that tumor location，tumor size，depth of invasion，and lymphovascular invasion were independent risk factors for lymph node metastasis（OR=4.433，2.097，3.510，43.701，P < 0.05）.④In the surgical group，the lymph node metastasis rate of of patients suitable for absolute criteria and expanded criteria of ESD were1. 96% and 3.79%，respectively. There were no statistically significant differences in lymph node metastasis rate between patients met absolute criteria and expanded criteria（F=0.428，P=0.51）. Conclusion：Some of patients who met the extended indications of ESD chose surgery，and some of them could use ESD. The treatment accuracy and curative resection rate of undifferentiated patients were low. The tumor located in the middle-third of the stomach，the tumor size>2 cm，submucosal invasion and lymphovascular invasion were independent risk factors for lymph node metastasis.