Objective To investigate the impact of noise isolation through the use of noise-cancelling headphones on the quality of postoperative recovery following esophageal or gastric endoscopic submucosal dissection. Methods This is a prospective， parallel-group， randomized controlled clinical trial. Patients aged 18 years or older， regardless of gender and with ASA physical status Ⅰ- Ⅳ， who underwent elective esophageal or gastric endoscopic submucosal dissection under general anesthesia with endotracheal intubation from August 2023 to February 2024 were randomly assigned to either a control group or an observation group using a random number table. In the observation group， noise-cancelling headphones were used to reduce intraoperative noise intensity during general anesthesia， while the control group did not receive any noise isolation measures. The study recorded the average noise intensity during surgery and the proportion of intraoperative time with noise intensity ≥ 70 dB. The primary outcome was the quality of recovery at 24 hours postoperatively， assessed using the 15-item Quality of Recovery Scale （QoR-15）. Secondary outcomes included QoR-15 scores at 48 hours postoperatively， resting and movement-evoked pain scores measured by the Visual Analog Pain Scale （VAS） immediately after extubation， upon leaving the resuscitation room， and at 24 and 48 hours postoperatively， as well as analgesic drug consumption during surgery and within 48 hours postoperatively. Additionally， sleep quality was evaluated using the Pittsburgh Sleep Quality Index （PSQI） at 48 hours postoperatively. Results Compared with the control group， the observation group exhibited a significant increase in QoR-15 score at 24 hours post-surgery ［（123.43 ± 5.92） vs. （119.75 ± 6.62）， t = 3.211， P = 0.002］. The resting VAS score ［1（0，3） vs. 2（2，3）， Z = -3.755， P < 0.001］ and movement-evoked VAS score ［2（1，3） vs. 3（2，3）， Z = -2.959， P = 0.003］ of the observation group immediately after extubation were significantly lower than those of control group. There was no significant difference in resting and movement-evoked VAS scores between the two groups when leaving the resuscitation room or at 24 and 48 hours after surgery （P > 0.05）. The intraoperative fentanyl consumption was significantly lower in the observation group compared to the control group ［（0.23 ± 0.05） vs. （0.27 ± 0.06）， t = 3.515， P = 0.01］. There were no significant differences in remifentanil consumption during surgery or in the frequency of rescue analgesia with flurbiprofen axetil within 48 hours post-surgery （P > 0.05）. Postoperative PSQI scores were significantly lower in the observation group compared to the control group ［（5.40 ± 2.57） vs. （6.63 ± 3.23）， t = 2.313， P = 0.022］. Conclusion The use of noise-cancelling headphones for intraoperative noise isolation is a safe and effective strategy that enhances postoperative recovery quality， alleviates postoperative pain， and decreases the overall consumption of analgesic drugs in patients undergoing endoscopic submucosal dissection of esophageal and gastric lesions under general anesthesia.