Background <p>Endoscopic submucosal dissection (ESD) is a common treatment for early esophageal cancer. Although ESD is considered safe, same-day discharge (SDD) is only feasible in selected patients. Therefore, identifying factors associated with the likelihood of SDD is crucial for optimizing patient selection and clinical management.</p> Methods <p>We conducted a retrospective analysis of patients with early esophageal cancer treated with ESD between August 2020 and July 2024. Patients were divided into SDD and non-SDD groups. Preoperative clinical features were compared between the groups. Univariate and multivariate logistic regression analyses were performed to identify independent predictors associated with the feasibility of SDD.</p> Results <p>Among 146 patients, 42 (28.8%) were discharged on the same day. Multivariate analysis identified larger lesion size (OR = 2.152, 95% CI: 2.037–2.280, <i>p</i> = 0.008), history of alcohol abuse (OR = 6.507, 95% CI: 3.169–11.211, <i>p</i> = 0.032), and tumor location in the upper esophagus (OR = 7.827, 95% CI: 5.481–14.547, <i>p</i> = 0.023) as significant factors negatively associated with SDD feasibility. Notably, larger lesions were associated with a lower likelihood of SDD.</p> Conclusion <p>Tumor size, upper esophageal location, and a history of alcohol abuse were identified as independent predictors associated with reduced feasibility of same-day discharge following ESD.</p>