Objective: To systematically evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) versus endoscopic mucosal resection (EMR) for early gastric cancer (EGC). Methods: The related literature of clinical studies was selected by searching several national and international databases, and the eligible studies that met the inclusion criteria were screened out and then assessed by Meta-analysis. Results: Fifteen case-control studies were finally included involving 4 673 patients, with 2 154 cases in ESD group and 2 519 cases in EMR group. Meta-analysis showed that the operative time was prolonged, but the en bloc resection rate, complete resection rate and curative resection rate were all increased in ESD group compared with EMR group (all P<0.05); as for the complications, the incidence of bleeding of the two groups had no statistical difference (P>0.05), but the incidence of gastric perforation was higher in ESD group than that in EMR group (P<0.05); the postoperative local recurrence rate in ESD group was lower than that in DMR group (P<0.05). Conclusion: For EGC, ESD offers high resection rate and low local recurrence rate, but has prolonged operative time and increased incidence of gastric perfusion. However, above conclusion needs further verification by high-quality clinical studies with larger sample size.