Objective：The purpose of this study was to compare the difference of clinical and pathological features between early gastroesophageal junction cancer and gastric cancer and analyze the endoscopic submucosal dissection （ESD） efficacy，to evaluate the ESD safety and effectiveness of early gastroesophageal junction cancer. Methods：We retrospectively analyzed 338 patients who underwent ESD in the First Affiliated Hospital of Nanjing Medical University from January 2013 to February 2019，who were confirmed as early cancer by postoperative pathology. According to the location of lesions，157 cases of early gastroesophageal junction cancer were studied as the study group and 181 cases of gastric cancer as the control group. Results：Multivariate analysis showed that age ≥62.5 years，male，endoscopic flat type，differentiated adenocarcinoma and submucosal infiltration were independent risk factors for early gastroesophageal junction cancer（OR=2.182，2.299，2.497，2.425，2.939，P < 0.05）. The operation time of the early gastroesophageal junction cancer group［（104.14 ± 58.49）min］was longer than that of the gastric cancer group［（73.39 ± 45.06）min，P＜0.05］，and the curative resection rate was lower than that of the gastric cancer group（70.7% vs. 80.7%，P=0.032）. According to Kaplan-Meier analysis，there was no statistically significant difference in the overall survival rate（Log-rank P=0.889）and the survival rate of patients with curative resection（log-rank P=0.712） between the two groups. Univariate analysis showed that lesion diameter ≥2 cm（91.3% vs. 67.6%，P=0.002），poor pathological type（21.7% vs. 0.9%，P < 0.001），submucosal infiltration（60.9% vs. 13.5%，P < 0.001），lymphatic vascular infiltration（4.3% vs. 0，P=0.027），ulceration（23.9% vs. 5.4%，P < 0.001） were risk factors for noncurative resection of early gastroesophageal junction cancer. Conclusion：ESD is a safe and effective treatment for early gastroesophageal junction cancer，but the curative rate of ESD treatment is reduced for early gastroesophageal junction cancer with lesion diameter ≥2 cm，poor pathological type differentiation，submucosal infiltration，lymphatic vessel infiltration and ulcer.