Objective?To evaluate the basis of following surgery or radiotherapy after endoscopic submucosal dissection (ESD) in patients with early esophageal carcinoma.?Methods?From July 2009 to October 2015, 112 patients with early esophageal carcinoma underwent ESD, and the characteristics of clinical information, post-op pathology results and follow-up were recorded.?Results?Among the patients, 7 cases received the following therapy, including 3 with esophageal radical surgery, 1 with gastric cardia radical surgery and chemotherapy for the lymphatic metastasis, 1 with another ESD and 2 with radiotherapy. Invasive depth in these 7 patients was epithelium (ml) in 3 cases, upper 1/3 in submucosa (sm1) in 3 and muscularis mucosa (m3) in 1. Vascular metastasis was found in 1 case, without endoscopic local recurrence under endoscopic follow-up. However, CT revealed abdominal lymph node metastasis, and the patient died 16 months after the procedure. In another patient with high-grade intraepithelial neoplasia (HGIN) in the depth of m1, the surrounding margin of the lesion was negative without local recurrence in the following up for 7 months. CT found the liver and retroperitoneal lymph node metastasis.?Conclusion?The exact evaluation of invasive depth of the lesion and lymph node metastasis were the basis of the therapies. And following surgery or radiotherapy depended on the radical resection, local recurrence, lymph node and distant metastasis in the follow up.