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Low grade intraepithelial neoplasia （LGIN）, as a precancerous lesion of gastric mucosa, is intimately associated with gastric cancer. Whether LGIN patients need to undergo gastric endoscopic submucosal dissection （ESD） is still controversial. In this article,one case of synchronous multiple primary early gastric carcinoma was reported. Pathological biopsy indicated that one of the lesions was diagnosed with LGIN, and for two lesions, ESD was performed in two separate sessions with an interval of 3 months. Postoperative pathology showed that both two lesions were diagnosed with adenocarcinoma and the depth of infiltration of these two lesionswas both submucosa （SM1）, and the second lesion was complicated with gastritis cystica profunda. This case provides certain reference for endoscopic treatment of highly suspicious early gastric lesions with insufficient pathological evidence in clinical practice.