The therapeutic indication for endoscopic submucosal dissection (ESD) can be expanded to treat small-sized (＜2 cm) early gastric cancer (EGC) with undifferentiated histology. Here, we report the case of a 62-year-old woman in whom EGC was initially diagnosed by endoscopy and CT. She subsequently underwent ESD. Histological examination revealed a mixed type adenocarcinoma with poorly differentiated histology confined to the mucosa without ulcer and lymphovascular involvement. Subsequent regular examinations showed no recurrence for 7 years. She complained of fatigue and weight loss on the 7th year of follow-up. Radiologic examination showed multiple bone metastases and the bone biopsy specimen revealed adenocarcinoma re- sembling the previous EGC. (Korean J Helicoba cter Up Gastrointest Res 2016;16:46-51)