Objective: To analyze the correlation of classification and performance under gastroscope of superficial esophageal cancer and intraepithelial neoplasia and differences between biopsy pathology and surgical pathology. Methods: Totally 120 specimens of gastroscope and surgery were collected from January 2008 to December 2014, which diagnosed as early esophageal lesions by endoscopy, and confirmed as esophageal squamous cell carcinoma or precancerous lesions by pathology. Then analyzed the correlation of classification and performance under gastroscope and differences between biopsy pathology and surgical pathology. Results: The biopsy pathology which was completely in conformity with postoperative pathology was 60% (72/120), while the exacerbation was accounted for 37.5% (45/120) and the alleviation was accounted for 2.5% (3/120). The coincidence rate of superficial esophageal squamous cell carcinoma (SESCC) group was 90.5%, while the intraepithelial neoplasia group was 26.3%. There was a significant difference between them (P<0.05). The coincidence rate of type 1 was higher than type 3 (70% vs. 42.9%, P<0.05). The postoperative pathological analysis results of type 1, 2, 3 patients showed that there had an obvious increasing phenomenon in early mucous membrane and submucous infiltration (depth and transfer). It’s much easier to have a transverse deep infiltration and lymphatic metastasis when merging ulcer. Conclusion: Some differences existed between preoperative and postoperative pathology in SESCC. However, there had a certain relationship between gastroscopic classification and difference degree and provided an important clinical value in the involvement and differentiation of early esophageal lesions.