Mix the meatballs. In a large bowl, combine ground chicken, breadcrumbs, egg, green onion, garlic, ginger, soy sauce, salt, and pepper.
Stir until just combined. Avoid overmixing to keep the meatballs tender.
Shape the meatballs. Use damp hands or a small scoop to form 1 to 1 1/2-inch balls. You should get about 20–24 meatballs.
Brown the meatballs. Heat oil in a large skillet over medium-high.
Add meatballs in a single layer without crowding. Sear 2–3 minutes per side until lightly browned. Transfer to a plate; they’ll finish cooking in the sauce.
Sauté the veggies. In the same pan, reduce heat to medium.
Add bell pepper and onion with a pinch of salt. Cook 3–4 minutes until slightly softened but still crisp.
Build the sauce. Stir in ketchup, rice vinegar, brown sugar, soy sauce, sesame oil (if using), pineapple chunks, and pineapple juice. Bring to a gentle simmer, stirring to dissolve the sugar.
Thicken the sauce. Stir the cornstarch slurry to recombine, then pour it into the simmering sauce.
Cook 1–2 minutes until glossy and slightly thick.
Simmer the meatballs. Return the browned meatballs to the pan. Spoon sauce over them and simmer 6–8 minutes, turning occasionally, until the centers reach 165°F (74°C).
Taste and adjust. Balance the flavor: add a splash more vinegar for brightness or a teaspoon of sugar if you want sweeter. If it’s too thick, loosen with a splash of water or pineapple juice.
Serve. Spoon over warm rice or noodles.
Garnish with green onions and sesame seeds. Serve hot.