Background: We investigate the local recurrence rate and its risk factors among patients who underwent endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) and are judged as curative resection. Methods: We enrolled patients who were diagnosed as EGC and underwent ESD during 2006 and 2020. Local recurrence after ESD was confirmed by histopathologic evaluation by endoscopic biopsy at ESD site during endoscopic surveillance. Results: A total of 936 patients underwent ESD for EGC, achieved curative resection and were followed up more than 12 months. Among them, 14 cases of local recurrence were found (14/936, 1.5%) during 53.2 months of follow-up. Compared with patients without local recurrence, those with local recurrence showed male-predominance (677/922 vs. 14/14, P=0.025), frequent presence of synchronous tumor (123/922 vs. 6/14, P=0.001) and larger tumor size (16.3 vs. 26.3 mm, P=0.001). Kaplan-Meier graph also showed that local recurrence significantly occurred in subgroup with male, presence of synchronous tumor and tumor size ≥ 20 mm (P=0.028, 0.009 and <0.001 by log rank test, respectively). After propensity score matching for gender, age and comorbidities with 1:5 ratio, tumor size ≥ 20 mm was the only significant factor for local recurrence (odds ratio: 3.886, 95% confidence interval: 1.012-14.922, P=0.048) Conclusions: Endoscopists need to be cautious for local recurrence at ESD site even after curative resection of EGC, especially for large tumor size.