Gastric high-grade intraepithelial neoplasia is a pathologic concept that can be considered as an early stage cancer, confined within the epithelial cell layer. Gastric high-grade intraepithelial neoplasia generally requires surgical intervention, with the options of gastrointestinal endoscopic ESD, luminal as well as open surgery. High-grade gastric intraepithelial neoplasia, which includes severe heterogeneous hyperplasia and carcinoma in situ, has a high likelihood of progressing to gastric cancer, and endoscopic biopsies may be subject to a certain degree of unavoidable bias, so surgical intervention is generally recommended. If the lesion is superficial and the size of the lesion is <1 cm, endoscopic mucosal dissection (ESD) can be considered to remove the lesion. However, if the lesion is deeper, larger, and surrounded by suspected lymph node metastasis, open or laparoscopic radical surgery should be performed, and postoperative lesion specimens should undergo routine pathologic examination. Generally speaking, high-grade intraepithelial neoplasia of the stomach can be followed up and observed after surgery, but if the postoperative pathology shows the existence of cancer foci, radiotherapy, chemotherapy and other comprehensive treatments may be needed according to the condition. It is recommended that the patient should consult the doctor as soon as possible and follow the doctor's instructions for further examination and treatment to avoid delaying the progression of the disease.