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Background the aim of the study was to clarify the frequency of colorectal neoplasm (CRN) complicating superfi cial esophageal squamous cell carcinoma (ESCC) and the need for colonoscopy. Methods We retrospectively reviewed 101 patients who had undergone initial endoscopic resection (ER) for superfi cial ESCC. Control group participants were age- and sex-matched asymptomatic subjects screened at our hospital over the same period of time. Advanced adenoma was defi ned as an adenoma ⩾10 mm, with villous features, or high-grade dysplasia. Advanced CRN referred to advanced adenoma or cancer. We measured the incidence of advanced CRN in superfi cial ESCC and controls, and we compared the characteristics of superfi cial ESCC patients with and without advanced CRN. Results In the superfi cial ESCC group, advanced CRNs were found in 17 patients (16.8%). A history of smoking alone was found to be a signifi cant risk factor of advanced CRN [odds ratio 6.02 (95% CI 1.30-27.8), P=0.005]. Conclusion the frequency of synchronous advanced CRN is high in superfi cial ESCC patients subjected to ER. Colonoscopy should be highly considered for most patients who undergo ER for superfi cial ESCC with a history of smoking, and is recommended even in superfi cial ESCC patients. [ABSTRACT FROM AUTHOR]