Early-stage gastric signet ring cell carcinoma originates from undifferentiated stem cells at the neck of the gland in the lamina propria. It can spread widely through the mucosal layer, but generally invade into the submucosa at a low speed, therefore, the treatment effect is better when it is limited to the mucosal layer. However, once breaking through to the submucosa, it will quickly spread and metastasize. The early detection of the disease is extremely significant, suggesting that better awareness to find the lesion, a better ability to make endoscopic diagnosis and standard operation are required. And this is the only way that SRCC can get treatment at an early-stage. Early-stage of signet ring cell carcinoma is classified as undifferentiated type. According to previous reports, its endoscopic findings are mainly based on the destruction of the glands and typical microvessels found under ME-NBI. Professor Yagi summarized its typcial microvessels into three types: raimon vessels, wavy microvessels and corkscrew pattern[11,12]. Phalanusitthepha et al.  reported that the typical endoscopic finding of early-stage signet ring cell carcinoma is a widened intervening part (IP), which is called "stretch sign". The two cases of signet ring cell carcinoma found in our center were both due to physical examinations and asymptomatic, and both were type 0-IIb lesions with mucosal atrophy after eradication of H. pylori infection. It is difficult to find a whitish lesion in whitish atrophic mucosa. We combine the white light endoscopy and image enhancement endoscopy (IEE) (such as NBI) to make it easier to highlight the difference in hue to help with the diagnosis. Demarcation of such type 0-IIb lesions cannot be highlighted accurately after spraying with the indigo carmine dye. Magnifying endoscopic observation found that the MSP of the lesion is mainly characterized by the elongated and widened glands, and no typical raimon vessels, wavy microvessels or corkscrew pattern can be seen. It is difficult to identify a clear demarcation with ME-NBI. Size of the lesion determined by pathological results is consistent with that of the whitish area under NBI. We believe that the demarcation can be determined by white light endoscopy and non-magnifying NBI. If necessary, biopsies can be performed. We are also convinced that the depth of invasion of type 0-IIb flat lesion less than 2cm in size is within the mucosa, especially within the upper or middle layer of the lamina propria. The depth of invasion of early gastric cancer is limited to the mucosa or submucosa, but only when undifferentiated cancer is limited to the mucosal layer (cT1a) can endoscopic treatment be considered. Early-stage gastric signet ring cell carcinoma is classified according to the location of cancer cells in the lamina propria as the middle layer type, superficial layer type, and whole layer type which can be determined according to MVP and MSP under ME-NBI[15,16]. Endoscopic submucosal dissection (ESD) is widely accepted as a minimally invasive treatment for early intramucosal gastric cancer, with almost no risk of lymph node metastasis[17–19]. According to the "Guidelines for Gastric Cancer ESD/EMR (First Edition)" of Japanese Gastroenterological Endoscopy Society (JGES), UL0 cT1a undifferentiated-type carcinomas with a long diameter 2 cm or less is an expanded indication for ESD. After communicating the pros and cons of surgical and endoscopic treatment with the patients and their families, both patients finally chose surgical treatment. No recurrence or lymph node metastasis was found in the follow-up. In 2020, according to the "Guidelines for Gastric Cancer ESD/EMR (Second Edition)"  of JGES, UL0 cT1a undifferentiated-type carcinomas with a long diameter 2 cm or less has been classified as an absolute indication for ESD. Strict pathological evaluation and curative evaluation should be carried out afterwards. In addition, whether H. pylori-negative or H. pylori-positive signet ring cell carcinoma are given the same diagnosis strategy is worthy of our further study and discussion.