Objective To compare the efficacy of endoscopic treatment with surgical treatment for early gastric cancer accorded with expanded indications of endoscopic submucosal dissection （ESD）. Methods A total of 165 patients （167 lesions） with early gastric cancer underwent ESD （ESD group， 77 cases） or surgery （surgery group， 88 cases） from January 2011 to December 2016. The lesions fulfilled expanded indications of ESD， and were pathologically identified as differentiated or undifferentiated adenocarcinoma. Chi-square test， continuity-adjusted Chi square test， and Fisher exact test were used to analyze the incidence of lesion residual， local recurrence， metachronous recurrence， short-term complications and long-term complications. The 3-year overall survival rate and 3-year disease-free survival rate of the two groups were analyzed by Kaplan-Meier method. Results There were no differences on the incidence of lesion residual （P=0.473）， local recurrence （P=1.000） and metachronous recurrence （P=1.000） between the ESD group and the surgery group. The 3-year overall survival rate （100.0％ VS 98.3％， P=0.343） and the 3-year disease-free survival rate （98.1％ VS 96.7％， P=0.655） were not significantly different between the two groups. There was no significant difference on the incidence of short-term complications between the two groups ［7.8％ （6／77） VS 5.7％ （5／88）， χ2=0.294， P=0.588］. The incidence of long-term complications in the ESD group was lower than that in the surgery group ［0 （0／77） VS 8.0％ （7／88）， continuity-adjusted χ2=4.588， P=0.032］. Conclusion For patients with early gastric cancer fulfilled expanded indications of ESD， ESD has a lower incidence of long-term complications with similar efficacy compared to surgery.