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Background Gastrointestinal (GI) malignancies are a leading cause of mortality worldwide. Endoscopic submucosal dissection (ESD) is a well-established minimally invasive treatment for early lesions. To overcome the limitations of conventional ESD (CESDT), modified techniques such as the pocket creation method (PCM) or tunnel-endoscopic submucosal dissection (TESDT) were introduced. This meta-analysis aims to provide a comprehensive evaluation of T-ESD or PCM-ESD, compared to CESDT.Method We searched five databases (PubMed, Cochrane Library, Embase, Scopus, and Web of Science) from inception to September 10th, 2025. Randomized controlled trials (RCTs) and observational studies comparing T-ESD or PCM-ESD with CESDT for GI lesions were included. Outcomes included resection rates, procedural metrics, and complications.Results Twenty-four studies (3 RCTs and 21 observational studies) involving 3,677 patients were included. TESDT significantly increased en bloc resection rates (RR 1.04, 95% CI 1.02–1.07) and R0 resection rates (RR 1.06, 95% CI 1.02–1.11) compared to CESDT. Subgroup analysis revealed that the benefit for en bloc resection was driven by colorectal lesions and complex lesions (fibrotic, recurrent, or muscle-retracting). TESDT also significantly reduced procedure duration (MD, -9.01 min), increased resection speed (MD, 4.66 mm 2/min), and shortened hospital length of stay (MD, -0.27 days). Regarding safety, TESDT was associated with a significant reduction in intra-operative perforation (RR 0.41, 95% CI 0.24-0.68) and intra-procedural bleeding (RR 0.66, 95% CI 0.50-0.88). No significant differences were observed in curative resection, recurrence, or delayed complications.Conclusion TESDT/PCM-ESD offers superior technical efficacy and safety over CESDT, particularly for colorectal and complex gastrointestinal lesions.