Objective To evaluate the accuracy of optical coherence tomography(OCT)for invasion depth prediction of early esophageal cancer(EEC) and compare the clinical outcoming of OCT with magnifying endoscopy-narrow band imaging (ME-NBI)in assessment procedure. Methods Twenty-eight patients who were diagnosed with EEC and accepted OCT and ME-NBI assessment before endoscopic submucosal dissection(ESD)were enrolled in this prospective study. On the basis of the OCT and ME-NBI images, real-time prediction of EEC invasion depth was made. Postoperative pathological results were taken as golden standard to compare the accuracy of OCT with ME-NBI in evaluation of EEC invasion depth. The procedure time and complications during evaluation process were analyzed in the meantime. Result The overall accuracy of OCT and ME-NBI in predicting invasion depth of 28 EEC patients was 67.9%(19/28)and 75%(21/28)respectively,with no significant difference(P>0.05). The accuracy of OCT in distinguishing EP/LPM lesions was 78.9%(15/19). There was no significant difference compared with ME-NBI 68.4%(13/19,P>0.05). The procedure time of OCT was significantly shorter than that of ME-NBI [(6.0±2.9)min VS(16.3±5.4)min,P<0.001]. Conclusion The assessment ability of OCT in predicting invasion depth of EEC and distinguishing lesions located in the EP/LPM is comparable to the ME-NBI. Besides,OCT requires shorter procedure time for evaluation.