This study developed and validated a deep convolutional neural network (CNN)-based system to improve the detection rate of esophageal squamous cell carcinoma (ESCC) and high-risk esophageal lesions (HrELs) during endoscopy. In a clinical trial with 3,117 patients, the CNN-assisted endoscopy significantly increased the HrEL detection rate to 1.8%, compared to 0.9% in the control group (P = 0.029), with the system showing high sensitivity, specificity, and accuracy. These findings suggest that deep learning assistance can enhance early diagnosis and treatment of esophageal cancer, making it a valuable tool for screening.