Objective To systematically review the efficacy and safety of cap-assisted endoscopy in the treatment of esophageal foreign bodies. Methods PubMed, Web of Science, The Cochrane Library, EMbase, CNKI and Wanfang databases were searched by computer for relevant literatures on cap-assisted endoscopy and traditional endoscopy for esophageal foreign bodies from inception to November 2022. The quality assessment of the literature was conducted using the Newcastle-Ottawa Scale (NOS). Meta-analysis was performed using RevMan 5.4.1. Results Finally, 27 studies were collected, including 17 randomized controlled trials, 2 cohort studies and 8 case-control studies, with a total of 3 619 patients. All studies of NOS score were ≥7 points. Meta-analysis results showed that compared with traditional endoscopic treatment, the success rate of removing esophageal foreign bodies in the cap-assisted endoscopy group was higher (OR=14.43, 95%CI 10.64 to 19.55, P<0.000 1), postoperative complications were fewer (OR=0.30, 95%CI 0.23 to 0.38, P<0.000 1), patients' tolerance was better (OR=4.07, 95%CI 2.95 to 5.60, P<0.000 1), intraoperative visual field clarity was better (OR=12.00, 95%CI 7.29 to 19.76, P<0.000 1) and operative time was shorter (SMD=−1.83, 95%CI −2.31 to −1.34, P<0.000 1). Conclusion Cap-assisted endoscopy for esophageal foreign bodies is an effective and safe method, worthy of further promotion and application in clinical practice.