Gastric cancer is the fifth commonly diagnosed cancer worldwide. In comparison to the Asian countries, where population-based national gastric screening programs are implemented, most gastric cancers in Western countries are diagnosed at a later stage in the disease process. Endoscopic Submucosal Dissection (ESD) with curative resection is a well-established, effective, and safe technique for management of early gastric cancer. There is an overall agreement amongst all the major Asian, European and American Society guidelines regarding the indications for ESD of gastric cancerous lesions. ESD for early gastric cancer has been practiced for decades in the Asian Countries, however its adaptation in the Western countries has had a slower slope. Lack of training programs, fewer experts in the field, lower prevalence of gastric cancerous lesions, and lack of reimbursement code in the Western countries are amongst the major fundamental barriers that have hampered general adaptation of ESD for management of early gastric cancer in the West. The aim of this review is to compare incidence and risk factors for gastric cancer in the eastern and western countries and compare the outcomes of ESD between the two groups.