Objective To study the risk factors of recurrent and metachronous cancer of early gastric cancer (EGC) after endoscopic resection . Methods A retrospectively study was performed on the data of 309 patients (318 lesions) who underwent endoscopic mucosal resection or endoscopic submucosal dissection and were pathologically confirmed as EGC (including high-grade intraepithelial neoplasia) in the digestive endoscopy center of Shanghai Renji Hospital from October 2008 to December 2016. The risk factors of recurrent and metachronous cancer were analyzed using univariate and multivariate Cox regression analysis. Results The follow-up time ranged from 6 to 80 months, with median time of 26.6 months. Thirteen patients (4.2%, 13/309) had recurrence, and 8 (2.6%, 8/309) occurred metachronous cancer, and the total incidence rate of recurrent and metachronous cancer was 6.8% (21/309). The multivariate regression analysis showed that non-curative resection (P＜0.01, HR=5.73, 95%CI: 1.75-18.74) was the independent risk factor of recurrence, and moderate to severe mucosa atrophy around the lesions before resection (P=0.04, HR=4.87, 95%CI: 1.10-21.50) was the independent risk factor of metachronous cancer of differentiated EGC after endoscopic resection. Conclusion Recurrent and metachronous cancer of EGC after endoscopic resection are rare but cannot be ignored. Patients with non-curative resection should be alert to postoperative recurrence, and differentiated EGC patients with moderate to severe mucosa atrophy around the lesions before resection should pay more attention to metachronous cancer.