AIM:To elucidate the endoscopic features that predict the cancer following endoscopic submucosal dissection(ESD)in patients with high-grade neoplasia(HGN).METHODS:We retrospectively analyzed the medical records of patients who underwent ESD of gastric neoplasms from January 2007 to September 2010.ESD was performed in 555 cases involving 550 patients.A total of 112 lesions from 110 consecutive patients were initially diagnosed as HGN without cancer by forceps biopsy,and later underwent ESD.We classified lesions into two groups according to histologic discrepancies between the biopsy and ESD diagnosis.Gastric adenoma in the final diagnosis by ESD specimens were defined as adenoma group.Lesions with coexisting cancer after ESD were defined as cancer group.RESULTS:The mean age was 65.3 years,and 81 patients were male.There was no significant difference in the age or gender distribution between the adenoma(n=52)and cancer(n=60)groups.Thirty-six of these lesions(32.1%)showed histologic concordance between the forceps biopsy and ESD specimens,16(14.3%)showed a downgraded histology(low-grade neoplasia),and 60(53.6%)showed an upgraded histology(cancer).A red color change of the mucosal surface on endoscopy was found in 27/52(51.9%)of cases in the adenoma group and in 46/60(76.7%)of cases in the cancer group(P=0.006).Ulceration of the mucosal surface on endoscopy was found in 5(9.6%)of 52 lesions in the adenoma group and in 17(28.3%)of 60 lesions in the cancer group(P=0.013).In the multivariate analysis,a reddish surface color change and mucosal ulceration were significant predictive factors correlated with cancer after ESD of the HGN by forceps biopsy.CONCLUSION:HGN with a red color change or mucosal ulceration correlated with the presence of gastric cancer.These finding may help to guide the diagnosis and treatment. AIM: To elucidate the endoscopic features that predict the cancer following endoscopic submucosal dissection (ESD) in patients with high-grade neoplasia (HGN). METHODS: We retrospectively analyzed the medical records of patients who underwent ESD of gastric neoplasms from January 2007 to September 2010. ESD was performed in 555 cases involving 550 patients. A total of 112 lesions from 110 consecutive patients were initially diagnosed as HGN without cancer by forceps biopsy, and later underwent ESD.We classified lesions into two groups according to histologic discrepancies between the biopsy and ESD diagnosis. Genetic dysplasia in the final diagnosis by ESD specimens were defined as adenoma group. Lesions with coexisting cancer after ESD were defined as cancer group. RESULTS: The mean age was 65.3 years, and 81 patients were male. difference in the age or gender distribution between the adenoma (n = 52) and cancer (n = 60) groups.Thirty-six of these lesions (32.1%) showed histologic conco rdance between the forceps biopsy and ESD specimens, 16 (14.3%) showed a downgraded histology (low-grade neoplasia), and 60 (53.6%) showed an upgraded histology (cancer). A red color change of the mucosal surface on endoscopy was found in 27/52 (51.9%) of cases in the adenoma group and in 46/60 (76.7%) of cases in the cancer group (P = 0.006) .Ulceration of the mucosal surface on endoscopy was found in 5 (9.6% ) of 52 lesions in the adenoma group and in 17 (28.3%) of 60 lesions in the cancer group (P = 0.013). In the multivariate analysis, a reddish surface color change and mucosal ulceration were significant predictive factors correlated with cancer after ESD of the HGN by forceps biopsy. CONCLUSION: HGN with a red color change or mucosal ulceration correlated with the presence of gastric cancer. The finding may help to guide the diagnosis and treatment.