〔Abstract〕 Objective To investigate the clinical, endoscopic and pathological features of early esophageal squamous cell carcinoma with epithelial keratosis. Methods Patients with early esophageal squamous cell carcinoma confirmed by pathology after endoscopic submucosal dissection were collected. The patients were divided into two groups according to the manifestation of leukoplakia under endoscopy. The clinical, endoscopic and pathological data were collected and analyzed. Results Among the 263 patients with esophageal squamous cell carcinoma, 90 cases were complicated with epithelial keratosis. In patients with keratosis, the proportion of keratosis in patients over 60 years old was much higher than that in patients under 60 years old. Patients over 60 years old had a higher proportion of esophageal keratosis(81.11%vs66.47%,P=0.013) compared with non-epithelial keratosis group. Moreover, esophageal keratosis was more likely to occur in women(40.00%vs21.97%,P=0.002). In addition, more keratosis patients had a history of smoking than non-keratosis patients(35.56%vs23.70%,P=0.042). In patients with keratosis, there were more leukoplakia than those with scattered lesions, with larger lesions(80.77%vs48.44%,P=0.005) and deeper infiltration(M1: 3.85%vs20.31%; M2: 57.69%vs71.88%; M3: 26.92%vs4.69%; SM: 11.54%vs3.13%,P<0.001). Conclusion For elderly patients, women and people with a history of smoking, early esophageal squamous cell carcinoma is more likely to be complicated with esophageal keratosis. Clinicians should thoroughly observe the red area which is not completely covered by the white spots of keratosis. For the lesions with severe keratosis, we should be aware that the depth of invasion may be relatively deep.