Background <p>This study aims to compare the effectiveness and safety of traditional endoscopic submucosal dissection (ESD), endoscopic submucosal tunneling dissection (ESTD), and endoscopic submucosal dissection with C-shaped incision (ESD-C) in the treatment of superficial esophageal cancer and precancerous lesions, providing reference and guidance for the treatment of esophageal cancer.</p> Methods <p>A retrospective analysis was conducted on the clinical data of patients who underwent ESD (<i>n</i> = 96), ESTD (<i>n</i> = 103), and ESD-C (<i>n</i> = 98) for superficial esophageal cancer or precancerous lesions between January 2017 and December 2022. Through comparative analysis, the effectiveness and safety of the three surgical methods were evaluated, and the risk factors for postoperative esophageal stricture were explored.</p> Results <p>In terms of total operative time and dissection time, the ESD group &gt; ESTD group &gt; ESD-C group; in terms of dissection speed, the ESD group &lt; ESTD group &lt; ESD-C group; in terms of dissection area, the ESD group &lt; ESTD group and ESD-C group; and in terms of wound treatment time, the ESD group &gt; ESTD group and ESD-C group. In terms of surgical outcomes, the en bloc resection rate was 100% in all three groups, with complete resection rates of 86.84%, 90.79%, and 88.16% in the ESD, ESTD, and ESD-C groups, respectively. The risk factors for postoperative esophageal stricture included dissection area, circumferential proportion of the lesion, and injury to the muscularis propria.</p> Conclusion <p>Among the three surgical approaches, ESD-C demonstrated superior performance in operative time, resection speed, and procedural efficiency. Increased circumferential involvement of the lesion, larger resection area, and greater injury to the muscularis propria were associated with a heightened risk of postoperative esophageal stricture.</p>