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Background Despite the global use of endoscopic sub mucosal dissection (ESD) as a widely accepted approach for gastrointestinal cancer, there are many associated postoperative complications, including perforation, stenosis, bleeding, pneumonia, and others. We conducted this meta-analysis to evaluate the efficacy and safety of endoscopic hand suturing (EHS) for gastrointestinal cancer patients who underwent gastric ESD.Patients and Methods We included studies with patients undergoing EHS after ESD. We searched indexed databases (PubMed, Scopus, Web of Science, CEN TRAL, MEDLINE, Embase) until November 2024. We excluded case reports, case series, and conference abstracts. Continuous data were pooled as raw means, while dichotomous data were pooled as proportions, with 95% confidence intervals (CIs) for both.Results We conducted a comprehensive literature search of electronic databases, retrieving 2108 records. After thorough screening, nine studies involving 245 patients met the PICO criteria. The mean pooled suturing time to close the mucosal defect during EHS was 42.16min (95% CI [25.99–58.33]), while the time to complete the procedure was 43min (95% CI: [23.59–62.41]). The pooled analysis yielded a 95% complete closure rate (95% CI: [0.90–0.97]), which was not sustained in only 1% of cases (95% CI: [0–0.07]). For intraoperative complications, the rates of bleed ing and perforation were both 0% (95% CI: [0–1.00], [95% CI: 0–0.03]), while the postoperative rates were 3% (95% CI: [0.02–0.07]) and 1% (95% CI: [0–0.04]), respectively.Conclusion Endoscopic hand suturing demonstrates feasible suturing times and a favorable safety profile, supporting its potential role as a reliable adjunctive technique following gastric ESD. Keywords Endoscopic hand suturing · EHS · ESD · Endoscopic submucosal dissection · Gastric cancer · Postoperative bleeding · Perforation.