Endoscopic submucosal dissection (ESD) has become a standard treatment for early gastric cancer (EGC). 1-12 ESD involves circumferential mucosal incision and direct submucosal dissection, making it possible to resect en bloc even large tumors with endoscopically clear margins in any part of the stomach. The reported incomplete ESD resection rate is 7.4% to 26.3%, 1,2,13-19 and the reported local recurrence rate after ESD is 0% to 3%. 1,18-20 Incomplete resection leading to recurrent cancer in the stomach therefore continues to be problematic. Additional treatment is necessary in patients with incompletely resected lesions. We have reported ESD for residual/local recurrent EGC after EMR to be a safe, minimally invasive, effective procedure. 21 There are few published reports on the treatment of local recurrences of EGC after ESD, and it is difficult to carry out a second ESD because of scar formation resulting from the initial ESD. Between June 2005 and August 2012, we performed a second ESD in 12 patients with residual EGC lesions after having been treated with ESD, and we conducted a retrospective evaluation of the safety and efficacy of this method of treatment.