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Background EMR is currently a standard treatment for mucosal gastric tumors. Endoscopic submucosal dissection (ESD) has been developed for en bloc resection. Objective We evaluated the clinical outcomes of ESD compared with conventional EMR. Design Not applicable. Setting A historical control study was performed between EMR and ESD. Patients EMR of 245 gastric tumors was performed in 229 patients. Lesions were divided into two groups. Conventional EMR was performed in group A from February 1999 to June 2001, and ESD was performed in group B from July 2001 to March 2004. Group B was divided into subgroups: subgroup B-1 underwent ESD from July 2001 to March 2003 and subgroup B-2 from April 2003 to March 2004. Interventions All lesions were resected with conventional EMR or with ESD. Main outcome measurements En bloc resection rate, rate in completeness of resection, required time, remnant ratio, and complications were evaluated. Results With regard to lesions >10 mm in size, the en bloc resection rate and the rate in completeness of resection of group B was significantly higher than that of group A ( p < 0.01). Although the required time was longer in group B than A ( p < 0.01), it was shorter in subgroup B-2 compared with B-1 ( p < 0.05) with lesions □10 mm in size. The remnant ratio and perforation rate were not different between groups. Limitations Not applicable. Conclusions The en bloc resection rate was better with ESD than with conventional EMR. The required time was longer in ESD, but this disadvantage might be improved with experience.