Objective To assess the effectiveness and safety of endoscopic submucosal dissection (ESD) in the treatment of early esophagogastric junction (EGJ) cancer and precancerous lesion. Methods Clinical data of 67 patients with Siewert type Ⅱ early EGJ cancer or precancerous lesion who underwent ESD at Endoscopy Center of Peking University First Hospital from July 2012 to June 2019 were retrospectively analyzed. Clinical and pathological features, technical data and complication rate were reviewed. The factors that may affect the curative resection were analyzed. Results Among the 67 cases, 5 were protruding type, 59 flat type, and 3 depressed type. The median lesion diameter was 1.6 (QR:1.8) cm, the median operation time was 60.0 (QR:56.0) min. The en bloc resection rate was 97.0% (65/67), the complete resection rate was 91.0% (61/67), and the curative resection rate was 82.1% (55/67). Factors related to non-curative resection were tumor size (OR=8.457, 95%CI: 1.227-58.302, P=0.030) and pathological type (OR=15.133, 95%CI: 1.518-150.870, P=0.021). ESD-related complications occurred in 3 cases (4.5%), including 1 case of delayed hemorrhage who received endoscopic hemostasis therapy, and 2 cases of post-operative cicatricial stricture who then received endoscopic dilation. Fifty-eight patients were followed up, and recurrence was found in 1 patient during follow-up with positive vertical margin who refused subsequent therapy.Metachronous early gastric cancer was found in another patient during follow-up, who was treated with a second ESD. Conclusion ESD is a safe, effective and less invasive technique for early EGJ cancer and precancerous lesion. Tumor size, boundary and infiltration depth of the lesion should be accurately evaluated before operation to formulate appropriate treatment strategies.