Meta-analysis was conducted to compare the safety and efficacy of endoscopic submucosal dissection（ESD）and surgery in the treatment of undifferentiated early gastric cancer.

We searched PubMed，Cochrane Library，EMBASE，CNKI，VIP database，Wanfang Data and other databases from the establishment of the database to May 2021. In this study，the methodological quality of the included literature was assessed using a non-random Study Bias Risk Assessment tool（RoBANS），and meta-analysis was performed using RevMan 5.3 software.

Eight studies were included，with 748 and 1567 participants receiving ESD and surgical treatment，respectively. Overall survival was higher in the surgery group than in the ESD group（P=0.01），and the ESD group had a higher recurrence rate（P<0.00001）and a lower complete resection rate（P<0.00001）than the surgery group. There was no significant difference in the incidence of adverse events between the two groups（P=0.76）.

For patients with undifferentiated early gastric cancer who meet the expanded indications，ESD treatment should be carefully selected，patients should be evaluated strictly according to the cure criteria，and additional surgical treatment should be considered for patients with postoperative pathological determination of hyperindication.