Enhanced recovery after surgery (ERAS) for endoscopic resection of upper gastrointestinal lesions ≤ 2 cm: a single-center, 1:2 randomized, controlled, non-inferiority trial
In brief
ERAS matched standard care on complications and sped recovery after resection
In a single-center randomized trial of 165 patients with upper gastrointestinal lesions 2 cm or smaller, enhanced recovery met the prespecified standard for non-inferiority on postoperative complications. Patients drank water about 24 hours after surgery, versus 65 hours with standard care, and had shorter hospital stays and lower costs; whether these results extend beyond selected patients at one center remains unknown.
- Journal
- Surgical endoscopy (Q1)
- Published
- 19 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Guoyao Sun, Wen Jia, Zhixin Liu, Yanan Sun, Feng Gao, Yong Sun, et al.
- PMID
- 42897336
- DOI
- 10.1007/s00464-026-13383-3
Why clinicians should know about it
- Picked for Gastroenterology (paper of the day, 22 October 2026): Non-inferiority trial, ERAS reduces complications and stay
Abstract
OBJECTIVE: This study aimed to preliminarily evaluate the non-inferiority of ERAS-based perioperative management in endoscopic resection for upper gastrointestinal lesions. METHODS: A total of 165 patients with upper gastrointestinal lesions ≤ 2 cm undergoing endoscopic resection (STER, ESD, ESE, or EFTR) were randomized 1:2 to the ERAS group (n = 55) or the conventional recovery after surgery (CRAS) group (n = 110). The primary outcome was postoperative complication rate, with a non-inferiority margin of 5%. Secondary outcomes included postoperative pain, recovery indicators, length of stay, and hospitalization costs. RESULTS: The risk difference in postoperative complications between the ERAS group and the CRAS group was - 0.91% (90% CI [- 3.97% to 3.83%]), meeting the prespecified criterion for non-inferiority. The ERAS group also showed significantly lower VAS pain scores (0.0 [0.0-3.0] vs. 2.0 [0.0-3.3]; p = 0.020), shorter nasogastric tube duration (3.0 [2.0-3.0] vs. 4.0 [3.0-4.0] days; p < 0.001), and earlier time to first oral water (23.9 [18.5-32.5] vs. 64.7 [56.2-77.0] hours; p < 0.001), first oral feeding (33.2 [22.5-38.5] vs. 70.3 [59.2-79.8] hours; p < 0.001), and first ambulation (36.8 [27.0-45.5] vs. 76.1 [62.0-86.0] hours; p < 0.001). Postoperative length of stay, total length of stay, and hospitalization costs were also significantly reduced (all p < 0.001). CONCLUSION: In this single-center trial involving selected patients with upper gastrointestinal lesions ≤ 2 cm, ERAS met the prespecified criterion for non-inferiority to CRAS with respect to postoperative complications. ERAS was also associated with shorter hospital stays and lower hospitalization costs.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.