Objective: This study aims to analyze and summarize both the endoscopic and clinicopathological characteristics of Helicobacter pylori (helicobacter pylori,HP) negative early gastric cancer. Methods: Patients diagnosed with early gastric cancer at the Affiliated Hospital of Qingdao University between June 2013 and March 2024 were retrospectively gathered and included based on the diagnostic criteria for HP-negative gastric cancer. The study analyzed their clinical baseline characteristics, endoscopic observations, and histopathological features. Results: Among the 698 patients diagnosed with early gastric cancer, 29 were identified as having HP-negative gastric cancer, accounting for an incidence rate of 4.2%. These 29 patients presented with a total of 30 lesions. Several typical types of gastric cancer were observed, including 13 cases of oxyntic gland adenoma (OGA) or gastric adenocarcinoma of fundic-gland type (GA-FG), and 2 cases of fundus glandular mucosal gastric cancer (GA-FGM), predominantly located in the middle and upper regions of the stomach. These lesions often appeared as polypoid or small submucosal tumor (SMT)-like protrusions visible under white light endoscopy, exhibiting whitish or reddish discoloration with branched dilated blood vessels on the surface. The demarcation line (DL) of most lesions was indistinct; Foveolar epithelial gastric cancer, also known as gastric adenocarcinoma of foveolar type (GA-FV), was observed in 3 lesions, primarily situated in the middle region of the stomach. These lesions appeared as red protuberant formations under white light endoscopy. There were 6 cases of signet ring cell carcinomas, predominantly found in the middle and lower regions of the stomach. These presented as flat or shallow depressions with whitened lesions when examined under white light endoscopy, mostly manifesting as small lesions with indistinct boundaries. Additionally, there were no cases of intestinal type adenocarcinoma, while 4 cases of pyloric adenocarcinoma and 2 cases of poorly differentiated tubular adenocarcinoma were identified. The white light and NBI endoscopic findings for the latter two types showed no significant difference compared to HP-positive early gastric cancer. Conclusion: HP-negative gastric cancer exhibits distinctive endoscopic and pathological characteristics. The differentiated type is more prevalent than the undifferentiated type, with an onset typically at a younger age. Furthermore, females are more frequently affected than males, and the majority of cases are situated in the upper part of the stomach, often presenting with protuberant lesions.