In Japan, differentiated-type early gastric cancer with submucosal invasion <
500 µm, tumor diameter <
3 cm, no lymphovascular invasion, and negative resection margin are included in pathological curative criteria after endoscopic resection (ER). However, there are a few reports presenting local or metastatic recurrence after ER for the lesions described above. A 72-year-old man was diagnosed with early gastric cancer and underwent endoscopic submucosal dissection (ESD). Pathological diagnosis was well-differentiated tubular adenocarcinoma, 8 × 6 mm, T1b1(SM1
428 µm below the muscularis mucosae), negative lymphovascular invasion, and negative resection margin, which was included in curative criteria. Eighteen months after ESD, the laboratory studies indicated an increase in carcinoembryonic antigen of 17.6 ng/mL (normal range <
5 ng/mL). While endoscopy showed no local recurrence finding, contrast-enhanced computed tomography (CT) showed a metastatic liver tumor in S4. Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging and