BACKGROUND Endoscopic submucosal dissection (ESD) of early gastric cancer is less invasive than surgical resection, and if technically feasible, it may result in less long-term morbidity than does incisional surgery. However, ESD is technically difficult in patients who have had a previous distal gastrectomy. OBJECTIVE Our purpose was to retrospectively assess the results of ESD of early gastric cancer in the remnant stomach. DESIGN Case series. SETTING AND PATIENTS A total of 31 lesions in 30 patients with early remnant gastric cancer were treated with ESD at Okayama University Hospital, Tsuyama Central Hospital, Hiroshima City Hospital, Kagawa Prefectural Central Hospital, and Mitoyo General Hospital from March 2001 to January 2007. INTERVENTION ESD. MAIN OUTCOME MEASUREMENTS En bloc resection rate, complete resection rate, operation time, and complications. RESULTS En bloc resection and complete resection were achieved in 30 (97%) and in 23 (74%) lesions, respectively. The median operation time required for ESD in the remnant stomach was 113 minutes (range 45-450 minutes). Perforation occurred in 4 (13%). The incidence of delayed bleeding requiring blood transfusion was 0%. LIMITATION Short duration of follow-up. CONCLUSIONS ESD is feasible in the remnant stomach but has a relatively high complication rate and should only be performed by experienced endoscopists.