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Background/Aims New endoscopic resection techniques are constantly being developed for gastric adenoma, which can be classified as low or high grade according to the Vienna classification. However, long-term data on gastric adenoma (e.g., removal or follow-up after resection via endoscopy) remain lacking. We investigated long-term outcome of gastric adenoma after endoscopic resection and risk factors for recurrence. Methods We retrospectively analyzed 133 cases with gastric adenoma that underwent endoscopic resection from January 2010 to November 2018 at Haeundae Paik Hospital, Inje University School of Medicine, Busan, Korea. One hundred six (79.7%) and 27 patients (20.3%) received endoscopic resection once and more than twice, respectively. Results Compared with the initial endoscopic biopsy pathological results, the upgraded and downgraded histological discrepancy rates were 10.5% (n=14) and 3.0% (n=4) after resection, respectively. The mean time to recurrence was 2.23 years. The most common endoscopic gross finding was flat lesions (58.6%). The lesions were found frequently in the antrum (52.6%; long axis) and lesser curvature (39.8%; short axis). Eleven (8.3%) and 16 patients (12.0%) had recurred synchronous and metachronous lesions, respectively. In the multivariate cox analysis of the recurrence group, intestinal metaplasia (hazard ratio, 2.761; 95% confidence interval, 1.117 to 6.820; p=0.028) and lesion size (hazard ratio, 1.607; 95% confidence interval, 1.082 to 2.385; p=0.019) were independent factors for receiving endoscopic resection more than twice. Conclusions If patients have severe intestinal metaplasia or large size of lesion at endoscopic resection for gastric adenoma, periodic observation is necessary. [ABSTRACT FROM AUTHOR]