Development and Validation of a Novel Risk Stratification Algorithm for Same-Day Discharge After Endoscopic Submucosal Dissection

Background: Same-day discharge (SDD) after endoscopic submucosal dissection (ESD) offers cost reduction and improved patient satisfaction, but a validated algorithm for safe SDD is lacking. This study aimed to validate a novel discharge model integrating clinical, laboratory, and patient-reported outcomes. Methods: In this prospective observational study, 518 adult patients undergoing ESD for early gastrointestinal neoplasms at a high-volume center were evaluated. A risk-stratification algorithm using VAS pain scores, hemoglobin (Hgb) decline, and clinical stability determined SDD eligibility. Primary outcomes included safety, measured by complication and readmission rates. Secondary outcomes assessed pathology, patient satisfaction, and recurrence at six and twelve months. Results: Of 518 patients, 92.5% (n=479) were discharged on the same day, while 7.5% (n=39) required overnight observation. Complication rates were significantly lower in the SDD group (3.8% vs. 87.2%, p<0.001). SDD patients reported lower fourth-hour VAS pain scores (2 [IQR: 1–4] vs. 7 [IQR: 5–8], p<0.001) and smaller Hgb declines (0.2 [IQR: 0.1–0.3] mg/dL vs. 2.2 [IQR: 1.3–3] mg/dL, p<0.001). Six-month recurrence was 2.7% (n=14) with no significant group difference (p=0.080). Patient satisfaction was higher in the SDD group (8 [IQR: 8–9] vs. 3 [IQR: 3–4], p<0.001). Conclusion: This study validates a multifactorial algorithm for safe SDD after ESD. The model reduces complications and optimizes resource use without compromising oncologic or patient outcomes, providing a cost-effective framework for high-quality care.