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The Effect of Background/Aims: Helicobacter pylori (Hp) infection is an important risk factor for gastric carcinogenesis. Although several studies have investigated the effect of Hp eradication on the development of metachronous neoplasm after endoscopic resection of the gastric dysplasia, the evidence is still insufficient to make a clear conclusion. The aims of this study was to evaluate the risk factors for the development of metachronous neoplasm after endoscopic resection of gastric dysplasia and to investigate the effect of Hp eradication. Methods: Between 2005 and 2011, a total of 887 patients underwent endoscopic resection for gastric dysplasia. Among them, 521 patients who had undergone tests for Hp infection and been followed-up for at least one year were included in the final analyses. Of the 292 Hp-positive patients, 116 patients were successfully eradicated, while 176 failed or did not undergo eradication. Results: During a mean follow-up of 59.1 months (range 12-125 months), metachronous neoplasm had developed in 63 patients (12.1%, dysplasia in 38, carcinoma in 25). In multivariate analyses, age ≥65 (hazard ratio [HR]=2.247, 95% confidence interval [CI] 1.297-3.895), tumor size (HR=1.283, 95% CI 1.038-1.585), synchronous lesion (HR=2.341, 95% CI 1.244-4.405), family history of gastric cancer (HR=3.240, 95% CI 1.776-5.912), and smoking (HR=1.016, 95% CI 1.003-1.029) were risk factors for metachronous neoplasm after endoscopic resection of gastric dysplasia. However, Hp eradication was not associated with metachronous neoplasm (HR=0.641, 95% CI 0.297-1.384). Conclusions: Hp eradication was not shown to be associated with the development of metachronous cancer after endoscopic resection of gastric dysplasia.