Objective To explore the effects of endoscopic submucosal dissection (ESD) and surgery on the long-term efficacy of patients with early gastric cancer.Methods Retrospective analysis of the clinical data of patients with early gastric cancer from November 2016 to March 2018 was divided into two groups according to the different treatment methods. The control group (n = 46) treated with surgery, the observation group (n = 46) underwent ESD.Results Operation time and hospitalization time in the observation group were significant shorter than those in control group , intraoperative blood loss and hospitalization expenses in the observation group were significant less than those in the control group. There was no significant difference in the 1-year, 2-year and 3-year survival rates between the two groups (P > 0.05). There was no significant difference in the recurrence rate between the two groups in the 1-year, 2-year and 3-year (P > 0.05). The total incidence of complications in the observation group was 4.35%, significantly lower than 19.57% of the control group, the difference was statistically significant (P < 0.05).Conclusion Compared with surgical operation, ESD for patients with early gastric cancer has shorter operation time and hospital stay, less bleeding and trauma, and lower risk of postoperative complications, which improves the prognosis of the patient and has a good therapeutic effect.