Objective?To investigate the clinical effect of endoscopic submucosal dissection in elderly patients with single early gastric cancer (EGC). Methods?126 elderly patients with single EGC from January 2010 to February 2015 were divided into elderly group (≥65 years old, n = 50) and young and middle-aged group (<65 years old, n = 76) according to age. Baseline data, operation time, volume of intraoperative blood loss, duration of postoperative hospital stay, rate of en bloc resection, curative resection; complications and result of follow-up were compared between two groups. Results?Age, the incidence of hypertension and coronary heart disease in elderly group were significantly higher than young and middle-aged group (P < 0.05). There were no significant differences in gender, history of diabetes, lesion morphology, size, pathological results and infiltration depth between two groups (P > 0.05). All patients were successfully completed ESD, and there were no significant differences in all perioperative data between two groups (P > 0.05). No tumor metastasis and death were occurred in all patients. Recurrence was occurred in a total of 3 cases. The recurrence rate of elderly group and young and middle-aged group were 2.0 % and 2.6% respectively, and there were no significant differences between the two groups (P > 0.05). Conclusion?For elderly patients with single EGC, ESD is a safe and feasible minimally invasive treatment, and it is equivalent to clinical efficacy and safety in young and middle-aged patients.