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The resection speeds for lesions of the ESTD were faster than those of cESD (19.3 mm /min versus 17.7 mm /min, P = 0.009). There was no need to use additional countertraction by clip-with-line technique or snare for the submucosal dissection in the ESTD procedure. The incidence of perforation was significantly higher in the cESD group (6.0%) than in the ESTD group (0.9%) (P = 0.035). Among 799 patients, four patients who received non-curative ESD had recurrence of gastric cancer. ESTD technique is a safe and feasible treatment procedur