From August 2021 to December 2023, 172 patients diagnosed with early gastric cancer and admitted to the Department of Gastroenterology at either the First Affiliated Hospital of Yangtze University or Jingzhou Central Hospital for ESD treatment were included in the study. Patients were randomly assigned to the ERAS group or the Control group using a computer-generated random number table. ( Figure 1 ) Inclusion criteria: 1) Age ≥ 18 years; 2) Indications for ESD treatment for early gastric cancer [9] ; 3) Informed consent obtained from the patient and family. Exclusion criteria: 1) Bleeding risk (e.g., use of antiplatelet or anticoagulant medications within the past week); 2) Intolerance to anesthesia or endoscopic procedures; 3) Non-curative resection; 4) Diabetes mellitus; 5) Non-compliant patients; 6) Incomplete clinical data. All procedures were performed by experienced endoscopists with over 10 years of expertise in ESD, and the study was approved by the hospital’s ethics committee (Ethics approval number: KY2023128).

(See Table 1 )

Preoperative: In the ERAS group, patients and families were thoroughly informed about the condition, the necessity of surgery, and the detailed endoscopic treatment plan. Preoperative psychological counseling and education based on the ERAS concept were provided using video viewing and consultations. Nutritional risk screening was performed, and enteral or oral nutritional therapy was initiated for patients with significant nutritional risk. Six hours before surgery, patients consumed 800 mL of 12.5% carbohydrate solution, and 3 hours before surgery, 400 mL. The control group received routine preoperative education and fasting for 6 hours.

Intraoperative: Both groups underwent general anesthesia with endotracheal intubation. Intraoperative monitoring of body temperature, electrocardiogram, respiration, blood pressure, peripheral oxygen saturation, and end-expiratory carbon dioxide pressure was performed.

Postoperative: In the ERAS group, a basic acid suppression and gastric protection protocol was followed with a relatively limited fluid infusion to meet physiological needs. On the first postoperative day, patients were given a liquid diet and assisted with ambulation for 1 - 2 hours. On the second day, they were given a semi-liquid diet and gradually transitioned to a normal diet. The control group received routine fluid management and gastric protection, with a liquid diet starting on days 2 - 3 after surgery and ambulation based on patient preference.

Psychological Health: Anxiety was assessed pre- and post-operatively using the Hamilton Anxiety Rating Scale (HAMA).

Perioperative Pain, Hunger, and Thirst: Evaluated using the Visual Analog Scale (VAS), measuring pain, hunger, and thirst at 2 hours and 24 hours postoperatively.

Postoperative Indicators: Time to first postoperative flatus, complications (nausea/vomiting, hypoglycemia, bleeding, perforation, fever), length of hospital stay, patient satisfaction (0 - 10 scale), and 30-day readmission rate.

Data were entered and processed using Excel 2019 and analyzed using SPSS 26.0. Categorical variables were expressed as numbers and percentages, and inter-group comparisons were made using chi-square tests or Fisher’s exact tests. Continuous variables were expressed as means ± standard deviations (± SD), medians, and ranges and compared using independent t-tests or rank-sum tests. A p-value of < 0.05 was considered statistically significant.

A total of 178 patients were evaluated for eligibility, with 51 excluded (32 with diabetes, 4 with bleeding risks, 3 requiring surgical resection, 6 non-compliant, and 6 with incomplete clinical data), leaving 127 patients included (62 in the ERAS group and 65 in the Control group). No significant differences were found between the two groups in terms of baseline age, sex, BMI, comorbidities (hypertension, diabetes), ASA classification, operative time, specimen size, invasion depth, or pathological grade (p > 0.05). ( Table 2 , Table 3 )

ASA: American Society of Anesthesiologists.

HAMA: Hamilton Anxiety Rating Scale; VAS: Visual Analogue Scale.