Objective To investigate the recurrence and risk factors of gastric high-grade intraepithelial neoplasia （HGIN） and early gastric cancer （EGC） after endoscopic submucosal dissection （ESD）. Methods The clinical and follow-up data on 444 patients （451 lesion） with HGIN and EGC undergoing ESD in Digestive Endoscopy Center of Chinese PLA General Hospital from November 2006 to January 2016 were summarized， and the risk factors of recurrence were analyzed. Results A total of 410 patients were followed-up， and the recurrence rate was 3.2％ （13 patients， 13 lesions）， with mean recurrence time of 17.6±9.6 months （6-38 months）. Univariate and multivariate analysis revealed that the size of the lesion＞4.0 cm was the only risk factor of recurrence（P=0.012，OR=10.855，95%CI：1.673~70.442）. Conclusion The rate of recurrence is increasing with the EGC extending， therefore， postoperative monitoring should be strengthened to patients with larger lesion.