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AIM: To evaluate the effectiveness of endoscopic submucosal dissection using an insulation-Upped diathermic knife (IT-ESD) for the treatment of patients with gastric remnant cancer.METHODS: Thirty-two patients with early gastric cancer in the remnant stomach, who underwent distal gastrectomy due to gastric carcinoma, were treated with endoscopic mucosal resection (EMR) or ESD at Sumitomo Besshi Hospital and Shikoku Cancer Center in the 10-year period from January 1998 to December 2007, including 17 patients treated with IT-ESD.Retrospectively, patient backgrounds, the one-piece resection rate, complete resection (CR) rate, operation time, bleeding rate, and perforation rate were compared between patients treated with conventional EMR and those treated with IT-ESD.RESULTS- The CR rate (40% in the EMR group ys 82% in the IT-ESD group) was significantly higher in the IT-ESD group than in the EMR group; however,the operation time was significantly longer for the ITESD group (57.6±31.9 min vs 21.1±12.2 min).No significant differences were found in the rate of underlying cardiopulmonary disease (IT-ESD group, 12% ys EMR group, 13%), one-piece resection rate (100% vs 73%), bleeding rate (18% vs 6.7%), and perforation rate (0% vs 0%) between the two groups.CONCLUSION: IT-ESD appears to be an effective treatment for gastric remnant cancer post distal gastrectomy because of its high CR rate.It is useful for histological confirmation of successful treatment.The long-term outcome needs to be evaluated in the future.