ObjectiveTo analyze the endoscopic and histological characteristics of Helicobacter pylori (HP)negative early gastric cancer (EGC) and high grade intraepithelial neoplasia (HGIN). MethodsData of patients diagnosed as having EGC or HGIN confirmed by pathology at the Seventh Medical Center of Chinese People′s Liberation Army General Hospital from January 2013 to January 2020 were collected. Patients were included according to the diagnostic criteria of HPnegative gastric cancer, and their endoscopic features and histopathological characteristics were retrospectively analyzed. ResultsAmong 469 lesions of EGC/HGIN, HPnegative lesions accounted for 21% (10/469), which included 3 signet ring cell carcinomas, 3 fundic gland type carcinomas, 1 foveolar adenocarcinoma, 1 HGIN of the cardia, 1 familial adenomatous polyposis with gastric HGIN, and 1 Lynch syndrome with gastric HGIN. The 3 cases of signet ring cell carcinoma were all whitish flat/depressed lesions and commonly seen in the lower part of the stomach (2/3). Most of the 7 cases of differentiated EGC/HGIN were elevated type (5/7) and commonly seen in the upper and middle stomach (6/7). ConclusionHPnegative EGCs are usually solitary lesions under gastroscopy. Undifferentiated type mostly appears whitish flat/depressed in the lower part of the stomach, while differentiated type appears elevated in the upper and middle part.